Requirements
Essential Job Functions
- General responsibility for processing administrative components of workflow process
- Receives and coordinates dispute referrals through data entry into our portal
- Downloading and processing of clinical & administrative documentation for the dispute
- Notating disputes within the portal regarding components of the workflow process
- Verifying and processing disputes for Conflict of Interest
- Validating eligibility of the dispute within the federally based ERISA program
- Requesting fees for the dispute process from the initiating and non-initiating parties
- Processing fees received assigning to clinical dispute reviewer
- Submitting final payment determinations to all parties through auto generated emails
- Meeting daily production requirements for assigned segment of workflow
- COI/Eligibility/Request Fees: 50 disputes daily
- Downloading NOOF/assignment to clinical reviewer: 50 disputes daily
- Submitting closure letters to all parties based on outcome: 50 disputes daily
- Conducts research driven projects surrounding cases of issue.
- Utilizes critical thinking to determine outlier processes with the rules of the program
- Ensures compliance processes and procedures are adhered to.
- Communicates with team regarding any disputes outside of standardized process
- Ensures seamless transition of all incoming disputes into the portal in a timely manner
- Ability to work via web-based portal applications
- Support others in a team environment
Knowledge and Abilities Requirements
- Ability to use Microsoft products (Word, Excel, PowerPoint, Outlook)
- Basic office equipment experience preferred (copier, fax, shipping and receiving tools)
- Written and verbal communication skills with a demonstrated ability to deliver excellent customer service
- Ability to multi-task and quickly adapt in a fast-paced environment
- Strong organizational skills
- Attention to detail
- Professional appearance
- General Typing Skills at 65wpm
- Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
- Proficiency in English
- Exemplary planning and time management skills
- Ability to work in high pressure, deadline driven environment
- Ability to multitask and prioritize daily workload
- High level verbal and written communications skills
- Critical Thinking Skills
Education and Experience:
- Bachelor or Master level degree in business or related discipline.
- 2-4 years of experience in an office based professional setting.