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Claims Coordinator

1199SEIU Family of Funds – New York, NY

Responsibilities

  • Consult and assist supervisors, manager in coordinating, distributing and finalizing Medicare Secondary Payer (MSP) cases and Medicaid reimbursement and Reconsideration claims
  • Verify member eligibility, review, organize and confirm essential documentation is appropriate
  • Audit all files once Quality Control Reviewers have reviewed and completed spreadsheets.
  • Train, coach and mentor staff on MSP and other claim procedures
  • Communicate (oral and/or written) with the various Government agencies, employers, members and partner with internal Fund stakeholders
  • Develop and update spreadsheets, maintain statistical analysis for preparation of data for program reports and presentation
  • Track and manage timely reposes ensuring Demand Letter deadlines are achieved
  • Research system problems, such as claims that did not process correctly. To ensure all claims are processed according to Fund Policies and Guidelines
  • Maintain MSP/Medicaid case files, purge and send closed cases as needed to Record Retentions for storage
  • Perform other duties as assigned by management

Qualifications

  • Bachelors degree or equivalent experience
  • Minimum of three (3) years as a medical Claims Quality Control Reviewer III or equivalent experience in a Healthcare environment
  • Knowledge of Claims processing, Medical Terminology, Third-Party Reimbursement, COB, MSP, CPT, ICD-9 and HCPCS codes
  • Excellent communication skills (oral, written, and listening); excellent interpersonal skills and ability to interact with diverse groups and maintain a pleasant attitude to ensure excellent customer service
  • Intermediate skill level of Microsoft Word and Excel; Access and Power Point preferred
  • Knowledge of 1199 Medical Claims Benefits, COBRA preferred
  • Extensive knowledge of The Funds policies preferred
  • Problem- solving and decision-making skills
  • Good attention to details and analytical ability
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