Claims Processor

Claims Processor

JOB TYPE: Full Time LOCATION: Circle of Health REPORTS TO: Circle of Health Benefits Manager SALARY RANGE: $20.01 - $31.39

Any individual who receives an offer of employment or will receive a payroll check are required to submit to a drug and alcohol test as a condition of obtaining employment. Mille Lacs Band Member/American Indian preference applies

SUMMARY: Circle of Health was developed to assist with premiums, co-pays and deductibles for the Mille Lacs Band of Ojibwe band members and their prospective families. This position processes claims and reimbursements.

QUALIFICATIONS: Two years of post-secondary education is preferred Three years' experience health insurance billing or claims experience. Knowledge of Medicare, Medicaid, and private insurance eligibility requirements. Basic computing skills in a Windows environment, including Word and spreadsheet software. Ability to work and communicate sensitively, confidentially, and effectively with band members, families, public agencies and co-workers. Very strong written and verbal communication skills. Knowledge of Data Privacy Act and ability to maintain strict confidentiality of band member, provider, and band information. Experience in and sensitivity to Native American culture. Ability to understand and follow directions. Must pass a background check. Must pass a pre-employment drug and alcohol test.

DUTIES AND RESPONSIBILITIES: Processes claims in a timely manner. Follows HIPAA regulations. Ensures that band members are using the correct and chronological avenues in acquiring insurance coverage, then directs them to the Benefit Coordinator. Assist band members with Medicare, Medicaid and other services. Assists with Office & File support when needed. Assists with band mailings. Creates denial letters and maintains correspondence on the ACT system. Maintains monthly log of denials, to present to Benefit Manager and Commissioner of Health and Human Services. In the absence of another Claims Processor/Benefit Coordinator will assist with band member inquiries to the best of their ability. In the absence of another Claims Processor/Benefit Coordinator will process reimbursement claims. Performs other duties as deemed appropriate by Circle of Health Benefit Manager.

WORKING CONDITIONS: Nature of work is such that incumbent experiences infrequent periods of moderate stress levels while dealing with band members, families, and others. Work is exclusively in doors in a controlled climate area. Little threat of personal danger or risk. Hours are typically 8-5, but possibly with some extra hours. May involve some evening or weekend work.

Submit resume, cover letter, and employment application to:

Mille Lacs Band of Ojibwe HR Generalist 43408 Oodena Dr. Onamia, MN 56359

Fax: View phone number on click.appcast.io

Email: View email address on click.appcast.io