Payment Integrity Claims Administrator

Payment Integrity Claims Administrator

Overview

6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy. We are currently seeking a Payment Integrity Claims Administrator to join our fun, fast-paced environment.

Role Summary

• Reviews insurance claims forms and documents for accuracy and completion
• Obtains missing information as necessary
• Supports clinical department through claims routing and finalization, workflow management and task tracking
• Monitor incoming and outgoing electronic claims via our internal processing system 
• Administrator of shared email inbox, routing messages and claims as appropriate and assuring task completion 
• Maintains records of all direct provider and client contacts 
• Enters manual claims to the claims system 
• Manages claims process from multiple clients and ensures all customizations are followed
• Research claim questions to properly route inquiries

Essential Role Responsibilities

• Support a culture that is consistent with 6 Degrees Health values and beliefs
• Works collaboratively with other departments to provide updates on claims status (RBP)
• Works collaboratively with other roles within the PI department to ensure claims are completed appropriately and within the designated TAT
• Works collaboratively with vendor partners, including but not limited to Rely Services and AMS on UB and IB conversions and keying.
• QA’s all work completed by vendor partners and reports results back to vendor partners for correction/education
• Finalizes claim reviews including client and provider report preparation
• QA all reports prior to submission to the client and provider
• Creates and QA’s all provider facing letters prior to submission
• Clearly document claims process and issue resolution  
• Identifies process gaps and works to improve workflows and procedures 
• Answers incoming PI calls and addresses any caller concern and/or routes the caller to the appropriate area
• Works collaboratively with Xorfox to identify and implement improvements and efficiencies within the Fennec system
• Other responsibilities or projects as assigned 
• Work includes the exercise of discretion and independent judgement with disbursement of mail which includes provider appeals and medical claims, disbursement of TPA, Plan and provider emails and   discretion and independent judgement with medical claims in EDI that need additional research

Minimum Role Requirements

• Associate degree or higher preferred
• 3-5 years of healthcare experience
• Expert user of Microsoft suite including Excel, Word, Visio, and PowerPoint
• Excellent verbal and written communication skills

Essential Role Functions 

• Must have the ability to read and understand various process flows and procedures 
• Strong internal and external communication skills, both verbal and written 
• Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary 
• Must be able to sit or stand for two hours at a time 
• Must be able to operate computers and phones to support position requirements 
• Strong Microsoft Office Skills are necessary 

Organizational Benefits

• Medical, Dental, Vision and Other Outstanding Ancillary Benefits
• Training and Development Opportunities
• 10 Paid Holidays
• 401k Program
• Remote Work Stipend
• Unlimited Paid Time Off
• Calm App Premium Membership

The base salary range for this position is between $38,000 and $50,000 plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.

At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.

6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

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