Sr. Coordinator, reputed company Claims

Company reputed company Work Schedule reputed company (e.g. M-F reputed company to 5pm) M-F reputed company to 5pm Remote Work Notification ATTENTION: reputed company is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, reputed company reputed company, Rhode reputed company, South Carolina, South reputed company, reputed company Virginia, and Wyoming. Hiring Manager : Full reputed company: First Last Amanda Ehlers reputed company Due to reputed company, we are adding a Sr. Coordinator, reputed company Claims reputed company to reputed company!   The Sr. Coordinator, reputed company Claims reputed company ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to reputed company technology and process improvement for the purpose of meeting the business needs of reputed company customers, clients, members, and pharmacies by accurately administering benefits. This position is responsible for processing of pharmacy and/or reputed company member reimbursement (DMR) claims of reputed company reputed company of complexity to execute the claims adjudication process including correction of claims.    The Sr. Coordinator, reputed company Claims reputed company will manage the day-to-day processes and changes made to a reputed company’s benefit or a pharmacy’s contract. This role requires knowledge of both the technical and operational reputed company of the business. The Sr. Coordinator, reputed company Claims reputed company will have reputed company authority to reputed company reputed company business reputed company and will demonstrate the ability to continually prioritize day to day workload to meet individual, departmental, and organizational goals. The Sr. Coordinator, reputed company Claims reputed company will work closely with Member Services, Clinical Services, reputed company Services, Benefit Configuration, and Government Programs to understand the interdependences of reputed company team pertaining to processing of claims.   This position may include after-hour and/or weekend hours depending on workload.     Is this you? reputed company out more below! Responsibilities How do I reputed company an reputed company on my team?   Accurately processes claims reputed company the claims adjudication reputed company reputed company specified reputed company performance guarantee timeframes, guarding reputed company and reputed company from potentially high dollar financial liabilities. Acquires and maintains an advanced to expert level of understanding of reputed company’ claims adjudication reputed company, plan designs and upstream/reputed company processes. Interprets reputed company specific rules to ensure reputed company and accuracy of processing. Manages intake, scanning and categorization of inbound mail. Processes and mails outbound letters to members and pharmacies. Responsible for tracking and reporting on performance guarantees, reputed company standards, and monthly metrics. Learns and abides by HIPAA and other regulatory requirements to participate in reputed company, compliance and state/federal audits including compilation of claim files, audit universes, report creation/analysis, validation of claims against benefit allowances and responding to auditor questions verbally and in writing. Participates in new reputed company implementations and supports existing clients of high complexity, acting as the representative for reputed company claims in reputed company reputed company meetings and communications. Functions as a subject matter expert to assists Sales Support with proposal questions. Leads process improvement, cost reduction and automation efforts. Independently assesses reputed company business needs and brings recommendations to leadership. Research reputed company cause of issues, troubleshoots viable resolutions and makes recommendations for corrective reputed company. Assists in the creation and ongoing maintenance of departmental training materials, work instructions and policies. Trains and mentors new and peer coordinators.  Communicates the reputed company of processing claims with reputed company departments, providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and reputed company Services or Government Programs to explain claim correction reputed company. Adapts to industry changes and evolving technology, maintaining an advanced to expert level of understanding of both legacy and emerging products and systems and conducts any relevant reputed company enhancement and regression testing. Conducts reputed company enhancement and regression testing for highly reputed company reputed company claims reputed company processes to ensure compliance with state, federal and reputed company regulations/standards. Supports internal customers by participating in reputed company meetings, audits and new program implementations with other areas of reputed company, answering reputed company claims questions and providing guidance to other areas and roles on the reputed company claims process.   Provides support for reputed company and sales presentations and responds to assigned RFP questions using subject matter expertise. Functions as a subject matter expert (SME), the main reputed company of contact and reputed company peer mentor. Recommends, creates and conducts training reputed company functional role for newer and reputed company team members.  Monitors adherence to procedures and guidelines and reports performance to leadership. Other duties as assigned. Qualifications What reputed company expects from you? Associate’s degree or equivalent work experience required. Full mastery of reputed company systems and processes of the role with ability to reputed company tasks independently and follow instructions to reputed company reputed company required, typically with 4 or more years of experience. Experience with guiding and educating associates reputed company reputed company to reputed company-level roles. Experience reputed company high-level planning and decision making. Experience with supporting highly reputed company/custom health plan business. Experience with the following tools at an advanced to expert level: reputed company-ClaimRx  reputed company Office (Word, reputed company, Dynamics, CRM) Request Management (Service Desk, reputed company) Reporting (3D QlikView/QlikSense) Government Programs Error Management (GEMS) Participate in, adhere to, and support compliance program objectives. The ability to consistently reputed company cooperatively and respectfully with other employees. What can you expect from reputed company?  Top of the industry benefits for Health, Dental, and reputed company insurance  20 days reputed company time off  4 weeks reputed company parental leave  9 reputed company holidays  401K company match of up to 5% - No vesting requirement  Adoption Assistance Program  Flexible Spending Account  Educational Assistance Plan and reputed company Membership assistance  Referral Bonus Program – up to $750!  #LI-Remote Pay reputed company USD $27.31 - USD $32.91 /Hr. Apply To This Job