What are the responsibilities and job description for the MHT Claims Coordinator position at The Health Plan of West Virginia Inc?
Job Description
Job Description
The Claims Coordinator position is responsible for assisting the manager and director with daily operational activities relating to claims payment, development of policy and procedures, customer service including monitoring of inventory levels, reassign work queues as needed, and provide team member guidance and support. Also responsible for the development of newly trained claims processing and customer service team as they exit the classroom training program.
Required :
High School graduate or equivalent
Knowledge of CPT and ICD10 Coding;
Knowledge of all claims types and coverage types for medical and hospital claims;
Previous experience with claims processing and / or call center;
Self-starter and works independently;
Detail oriented with good problem solving skills;
Ability to prioritize and meet deadlines;
Maintains confidentiality;
Good communication skills;
Proficient in Microsoft Office products (Word, Excel, Power Point);
Easily adapts to change in work requirements.
Desired :
Bachelor's degree from a accredited college or university;
Medical Terminology;
Knowledge of prescription coding (NDC);
Knowledge of state and federal regulations regarding claims payment guidelines;
Knowledge of HEART system claims processing capabilities and limitations preferred;
Five (5) years of experience in a claims processing environment with experience in all claims types.
Responsibilities :
Provides positive leadership and mentorship;
Maintains a positive, caring work relationship with others;
Assess issues and problem solves at root cause level;
Must develop a good understanding of reports, member EOB's and the system drivers that maintain the integrity of these tools;
Performs audits of new and existing claims staff. Tracks results and recommends training to managers;
Responds to written correspondence ina timely, professional and friendly manner;
Develops policy and procedures around claims processing guidelines;
Conducts refresher claims training with Claims Analyst and CSR;s
Speaks with providers or members as callers request escalation;
Reviews and releases high dollar claims according to guidelines of the plan;
Manages multiple tasks and priorities;
Records and communicates all information clearly and accurately;
Keeps all member protected health information (PHI) confidential;
Participate in external and / or internal trainings as requested;
Consistently displays a positive attitude and acceptable attendance;
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