What are the responsibilities and job description for the Balance Billing Coordinator position at 1199SEIU Benefit and Pension Funds?
Requisition #:
7153
# of openings:
1
Employment Type
Full time
Position Status
Permanent
Category
Non-Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
7153
# of openings:
1
Employment Type
Full time
Position Status
Permanent
Category
Non-Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
- Negotiate and resolve large volume of balance billing inquires, negotiate fees and discounts for members with non-participating providers to reduce out of pocket expenses;
- Communicate via telephone and written correspondence with providers, members, attorneys, or collection agencies to resolve balance billing/fee negotiation inquiries to com pletion; handle large call volume in reference to balance billing inquiries
- Analyze received correspondence; verify member eligibility, claim history and coordination of benefits
- Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover monies
- Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices
- Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner
- Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network
- Educate members and providers with out of network fees, out of pocket expenses and benefits of using the Funds network
- Perform additional duties and projects as assigned by management
- High School Diploma or GED required, some college or college degree preferred
- Minimum two (2) years experience processing medical professional and facility hospital claims preferred
- Experience negotiating bills and payments for managed care plans preferred
- Knowledge of provider contracts and collections processes preferred
- Excellent knowledge of health claims, eligibility rules, Coordination of Benefits (COB), 1199SEIU Benefit and Pension Fund and Retiree Benefits;
- Knowledge of Current Procedural Terminology(CPT) codes, andInternational Classification of Diseases(ICD-10) codes preferred
- Knowledge of health claims processing and benefit administration systems (QNXT and Vitech V3) preferred
- Familiar with provider databases, web-based applications and call tracking systems (i.e. Cactus, IObserver, BeneFAQs, Member and Provider Portal)
- Strong, analytical, and problem solving skills; able to work well independently and in a team oriented environment
- Basic skill level in Word, Excel and Access required
- Outstanding customer service skills; ability to maintain a pleasant attitude and provide excellent service to members and providers
- Excellent oral and written communication skills; must be able to communicate clearly with members, staff and external partners
- Must be able to work well under pressure, prioritize work with tight schedules and target dates in a high volume environment required
- Detail oriented with demonstrated organizational skills; ability to multi-task and follow up
