Claims Specialist I

Job Description

Job Description

SUMMARY: Responsible for the reconciliation of provider’s reimbursement request forms and maintaining all departmental filing. This role is also charged with communicating with the provider the proper process of filing claims as well as denial of claims.

ESSENTIAL FUNCTIONS
• Correlate the reimbursement request forms and resubmissions by provider per day in chronological order.
• Approval and denial claims for reimbursement and resubmissions.
• Responsible for generating and distributing copies of denied reimbursement request to providers.
• Filing all reimbursement forms.
• Assisting with special rates from the Call Center.
• Relays instructions, messages and other information as requested from the management team.
• Maintains a current working knowledge of all company policies, procedures, rules, regulations and memorandums.
• Responsible and accountable for updating management on changes and/or extraordinary circumstances affecting the company and/or transportation provider.
• Other duties as assigned by management team

REQUIRED SKILLS AND ABILITIES
• Excellent communications skills oral and written.
• Able to work in a busy environment.
• Able to function effectively in stressful situations.
• Knowledge of reconciliation and customer service policies and procedures.
• Knowledge of Medicaid Non-Emergency Transports preferred.
• Able to handle multiple tasks simultaneously.
• Proficient experience in Microsoft office suites (Word, Excel, Powerpoint).
• Following training, able to adequately implement concepts of Route Logic.
• Able to lift and/or move items up to 25 pounds.
• Data entry: Must be able to key 8000+ keystrokes.

QUALIFICATION
• High School diploma.
• Must have 1-2 years of claims experience.
• Must have 2-3 years of customer service experience.