Claims Intake Specialist II - Part Time Remote!

Important things YOU should know:

• Schedule: 8:00am - 1:00pm CST Monday - Friday
• Friday schedule includes covering a 7:00pm - 8:00pm shift on a rotational basis
• Fully Remote Opportunity
• Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
• Potential to Flex Schedule

What will YOU be doing for us? Responsible for ensuring departmental tasks are completed in order to meet client turnaround times for claim payment and authorization determination. Manages all special handling requests to support both internal and external requirements What will YOU be working on?

• Manages daily work plan and distributes work out to the team to ensure client turnaround times are met.
• Provide second tier support to data entry processors by providing direction how to resolve submission discrepancies according to client business rules.
• Manage specialized workflows to support client requests that deviate from standard processes and procedures. Coordinate resolution with required departments as necessary.
• Responsible for ensuring all reporting is reviewed, work queues are completed, and open issues are resolved prior to claim payment and authorization review. Proactively communicate readiness to transfer data to appropriate departments.
• Proactively communicate potential issues to management to allow for timely resolution.
• Ability to multitask within multiple modules of the Enterprise System to retrieve and research information along with processing any submission requests or special handling requests received.
• Comprehensive understanding of client processing guidelines and requirements.
• Process primary insurance carries EOB’s for appropriate payment.
• Act as a subject matter expert for items sent to the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
• Proactively bring forward provider submission errors and collaborate with internal teams for provider outreach and education.
• Manage and process urgent operating room (OR) authorization requests submitted via fax and coordinate with the authorization team to ensure timely review and determination outcome.
• Resolve provider data discrepancies submitted electronically that prevent the submission to proceed through the system. Utilize outside databases to validate provider credentials.
• Assists with training support of internal team members.

Additional Responsibilities:

• Partner with Claims Intake team in completing all other tasks as necessary to ensure accurate and timely completion of work to meet our client service level agreements.
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