Claims Coordinator

Claims Coordinator

Azul Vision is the largest eye care practice in Orange County, Inland Empire, and the Los Angeles area, with Twenty-Five locations and our newest location is Palm Desert to serve you conveniently and comfortably. Our world-class eye doctors are experts in all aspects of eye care as well as leading specialists in vision correction, cataract surgery, and laser eye surgery. We offer everything from cataract removal to cosmetic procedures such as eyelid surgery. You can rest assured you will receive cutting-edge treatment in a comfortable, friendly, and high-tech environment.

The Claims Coordinator will process and review claims for accuracy, completeness, and correct adjudication. Processes and review appeals, and resubmissions received from providers. Reviews reports to ensure proper coding and correct payment of claims.

Key Responsibilities:

• Reviews claims to make sure that billing requirements are met, and answers inquiries regarding claim status or denial.
• Processes clean claims and investigates problem claims.
• Reviews Estimated Utilization Review (EUR) accurately and timely.
• Resolves discrepancies and incorrect coding or billing on claims received.

• Process Providers Checks accurately and timely.
• Identifies and escalates claims with issues to manager when appropriate.
• Answers incoming and places outbound phone calls from/to providers regarding status of requests, new requests, eligibility, and answers general questions.
• Maintains authorization log.
• Performs other duties as assigned.

Leadership: Problem assessment. Creative problem solving. Interpersonal skills. Leadership abilities. Oral and written communication skills. Personal Leadership: Proactively sets, meets, and strives to exceed expectations. Communication: Is an open, clear confident communicator. Communicates effectively to ensure deliver best services to patients. Professionally communicate with patients and staff. Health and Safety: Comply with all company health and safety systems, policies, protocols, and legislative requirements. Is aware of the requirements that Azul Vision has in terms of Health & Safety and is committed to own safety and wellbeing and the safety of others in the workplace. Ensure own reporting of incidents, accidents and near misses. Ensure housekeeping in own work area provides a safe and healthy environment. Quality & Continuous Improvement: A high standard of quality work is produced. Actively participate in team discussions which includes opportunities for process improvements. Administration: Meets and/or exceeds agreed objectives/goals/KPIs. All written and verbal communication meets agreed standards.

Knowledge, Skills, Abilities: High school diploma or equivalent. Minimum two years-experience in data entry. Management of multiple tasks simultaneously. Strong organization with an attention to detail. Ability to work as a team member. Strong computer skills. Excellent verbal and written communication skills. Strong interpersonal skills. Ability to read and interpret basic business correspondence. Strong organizational skills and proven ability to multitask. Proactive work ethic and self-starter. Intermediate computer skill.

Personal Attributes: Strong communication skills. Comfortable to lead and implement change. Strategic. Has perspective. Proven decision making and problem-solving ability. Ability to build strong positive and enduring relationships internally and externally. Confident. Flexibility / adaptability. Professional. Personal integrity. Sense of humour. Team player.

Relationships and Roles: Demonstrates ability to interact and operate positively with patients, own team, all company employees, and suppliers. Maintains professional internal and external relationships that meet Azul Vision values. Approaches the role with an openness and willingness to learn, grow and improve and exudes qualities that colleagues respect. Proactively establish and maintain effective working team relationships with all departments.

Requirement: Full COVID-19 vaccination is an essential requirement of this role. Azul Vision will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance. Azul Vision requires all new hires and employees to report their COVID-19 vaccination status. Employees must comply with any state and local masking orders. In addition, when in an Azul building, employees are required to wear a face mask at all times. Or an approved exemption.