Medical Claims Specialist (Bilingual-Spanish)

Job Title: Medical Claims Specialist/CSR
Schedule: 11:30am-8pm (3 days) & 9:30-6pm (2 days)
Location: In-Office Glastonbury, CT

Summary: Growing Responsible for working in a fast-paced environment and having strong interpersonal and communication skills, attention to details, outstanding ability to multi-task and prioritize, and strong analytical skills. Performs administrative tasks related to client health premiums and out of pocket medical expenses, interact with clients to provide information in response to inquiries about products and services, and handle and resolve complaints by performing the following duties.

Duties and Responsibilities include the following.

1. Processes or adjust medical insurance claims in accordance with policies and procedures.

2. Answers phones and respond to client inquiries related to payments made on their behalf to medical providers.

3. Answers phones and responds to medical provider inquiries related to payments made or due to their office on their behalf of program clients.

4. Makes outgoing calls to medical providers and insurance companies.

5. Responsible for having the ability to read explanation of benefits and healthcare terminology.

6. Identifies, researches, resolves claim issues, and requests for additional documentation.

7. Promotes teamwork and service delivery success.

8. Ensures contractual performance guarantees related to payment processing timeliness and accuracy are met.

9. Ensures contractual performance guarantees related to various means of client communications are met such as phone, email, and mail.

10. Processes medical payments for clients.

11. Assists in the client appeals process.

12. Creates and updates financial batch records for processing by accounting.

13. Audits payment files and outgoing payments and checks accuracy of figures calculation.

*Essential Function

14. Manages workflow for the team to ensure service levels are achieved.

15. Manages call logs.

16. Works with client’s that have high medical utilization.

17. Recommends process improvements.

18. Performs other duties as assigned.

Education/Experience:
Associate's degree (A. A. / A. S.) or equivalent from two-year college or technical school; or two to four years related experience and/or training; or equivalent combination of education and experience.

Specialized Training:

Knowledge of medical insurance practices including enrollment, payment terms related to insurance premiums and out of pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort.

Certificates and Licenses:
Medical coding/billing or insurance claims processing required

Knowledge, Skills, and Other Abilities:

• Speaking which includes talking to others to Service Orientation which includes actively convey information effectively looking for ways to help people
• Knowledge of medical insurance practices Writing which includes communicating including enrollment, payment terms effectively in writing as appropriate for the related to insurance premiums and out of needs of the audience pocket expenses, benefits coordination with Reading Comprehension which includes an other insurance coverage, and ensuring understanding written sentences and payer of last resort paragraphs in work related documents
• Analytic Skills which includes the ability to Proficiency with all MS Office applications review and understand payment and including Microsoft Excel, Microsoft Word, account history and Microsoft Outlook
• Active Listening which includes giving full Strong problem solving and creative skills attention to what other people are saying, and the ability to exercise sound judgment taking time to understand the points being and make decisions based on timely made, asking questions as appropriate, and analyses not interrupting at inappropriate times Precise attention to detail

The above is intended to provide general guidance regarding the responsibilities of the position. It is not intended to be an all-encompassing definition of what the position entails and may be changed at the discretion of Senior Management at any time.

PAI is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law.

Job Type: Full-time

Pay: From $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Can you work the shift 11:30am-8pm? (eastern time)

Experience:

• Medical billing: 2 years (Required)

Language:

• Spanish (Required)

Work Location: In person