Claims Reconciliation Specialist (Onsite)

American Specialty Health; San Diego (CA); Vor Ort; USD 21.000 - 23.000; Vollzeit

Zusammenfassung

American Specialty Health is seeking a Reconciliation Representative to join our Claims department in San Diego, CA. The role focuses on reconciling 2-step claims and payments per EOBs from Health Plan payors for 2-step accounts, including mail handling and portal downloads.

The position is full-time and onsite. The ideal candidate will have claims processing experience, strong attention to detail, confidentiality, and ability to liaise with Health Plans to resolve denials or underpayments.

Qualifikationen

• High School Diploma or GED required.
• 2 years of claims processing, computer, typing, 10-key, and telephone skills.
• Knowledge of Microsoft Word and Excel helpful.
• Familiarity with Managed Care, HMO, PPO health plan provisions.

Aufgaben

• Reconciles, resolves, and researches 2-step claims and payments.
• Receives and sorts incoming mail including paper EOBs, faxes, Interoffice Mail, and Health Plan letters.
• Downloads electronic EOBs from Health Plan Portals.
• Count and scan EOBs and Health plan letters for distribution and track counts into daily inventory.
• Manually reconciles claims for payment from Health Plan Payors received by paper EOBs or spreadsheets.
• Makes calls to Health Plans to check status of claims and requests reprocessing if denied in error.
• Uses Health Plan and TPA websites to check on claim status or reconcile claims.
• Reconciles claims from various reports including 14-day, MO copay, fee schedule, unreconciled, and rejected reports.
• Notifies supervisors of trends related to invalid denials by TPAs or Health Plans.
• Documents comments in internal notes fields in IHIS and spreadsheets.
• Meets department production and quality requirements.
• Maintains confidentiality of all claims documents.

Kenntnisse

Claims processing

Interpersonal communication

Customer service

Microsoft Word

Ausbildung

High School Diploma or GED

Tools

Health Plan Portals

IHIS

10-key

Jobbeschreibung

American Specialty Health is seeking a Reconciliation Representative to join our Claims department in San Diego, CA. The role focuses on reconciling 2-step claims and payments per EOBs from Health Plan payors for 2-step accounts, including mail handling and portal downloads.

The position is full-time and onsite. The ideal candidate will have claims processing experience, strong attention to detail, confidentiality, and ability to liaise with Health Plans to resolve denials or underpayments.