Claims Workflow Coordinator

Midwest Operating Engineers Fringe Benefit Fund; Lyons Township (IL); On-site; USD 40,000 - 60,000; Full time

Job summary

Midwest Operating Engineers Fringe Benefit Fund is seeking a Claims Workflow Coordinator in Countryside, IL. The role coordinates, monitors, and oversees workflow operations within the Claims Department to ensure timely processing of medical claims and related information.

Responsibilities include subpoena coordination, distribution of communications, instrumenting workflow processes, and maintaining documentation.

Qualifications

• High school diploma or equivalent.
• Knowledge of medical terminology and claims processing.
• Ability to perform in a high-volume, quality-focused environment.
• Strong communication and problem-solving skills.

Responsibilities

• Coordinate subpoena requests and liaise with counsel and other departments.
• Distribute claims-related correspondence to members and providers.
• Monitor and process Laserfiche and Salesforce workflows.
• Track training materials and maintain accessible records.
• Review Medicare/Medicaid paper claims and CMS submissions as needed.
• Monitor production metrics and departmental dashboards.

Skills

Medical terminology

Attention to detail

Communication skills

Organizational skills

CPT/ICD-10

Education

High School diploma

Tools

MS Office

Workflow systems

Document management

Claims software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Workflow Coordinator

Countryside, IL, US

2 days ago Requisition ID: 1049

Summary/Objective:

The Workflow Coordinator works under general supervision to coordinate, monitor, and oversee workflow operations with the Claims Department. This role supports Claims Management and staff by tracking claims-related processes, facilitating workflow activities, monitoring operational timelines, and ensuring the efficient movement of medical claims and related information throughout the department.

Essential Functions:

• Coordinate subpoena requests by reviewing and compiling requested claims information, facilitating the collection of required documentation from other departments, and forwarding information to Fund counsel. Serve as a liaison with legal counsel to address questions and concerns regarding subpoena related matters.
• Facilitate the distribution of correspondence to members, authorized representatives, providers, etc. to support claims-related processes.
• Monitor and process Laserfiche requests in accordance with established procedures.
• Oversee the organization and maintenance of the training agenda library within OneNote to ensure information remains accessible, current and accurate.
• Monitor internal turnaround standards for claim processing and Salesforce cases, tracking workflow performance to support timely and accurate claim outcomes.
• Provide operational support for Salesforce and workflow related inquiries, facilitating issue resolution, escalating concerns when appropriate, and assisting staff with workflow processes and system navigation.
• Track Zelis stop-pay requests and coordination distribution to Claims Examiners for reissuance following confirmation.
• Review and triage Medicare and Medicaid paper claims, update Laserfiche records, and facilitate processing through the CMS electronic submission channel when appropriate.
• Monitor and track ICOB process notifications submitted to BCBS through the HUB, coordinating with Benefits & Eligibility to ensure ISSI records are updated and timely.
• Oversee and maintain tracking of QMSCO information received from Benefits & Eligibility to ensure timely follow-up and resolution.
• Monitor and route Salesforce cases, faxes, mail and ECMS items to the appropriate personnel to support efficient workflow management and timely resolution.
• Review incoming FSB claims to verify completeness and readability of documentation and coordinate responses when additional information is required.
• Track and report production metrics and downtime activity through departmental dashboards to support operational performance monitoring.
• Monitor and update provider profile information, payer contacts, W-9 documentation, and TIN records to maintain data integrity.
• Monitor and update departmental records, including examiner credentials, contact information and other operational tracking resources.
• Coordinate approval workflows and secure required authorizations for member and legal correspondence.
• Maintain provider information within various workflow applications.
• Provide backup support for priority claim assignment processes, including out-of-network returned claims with pricing and claims requiring negotiation approval.
• Coordinate fulfillment of large-volume Explanation of Benefits (EOB) copy requests.
• Complete CMS-related claim inquiries and facilitate timely resolution and submissions to CMS and Medicaid agencies.
• Provide backup operational support for the bi-weekly check run process to ensure continuity of workflow.
• Support monitoring and reporting activities associated with daily aging queues.
• Montior office supply inventory levels and place orders, when necessary.
• Audit bad-address claims, coordinate research efforts with Records and Information Management, and facilitate claim reissuance once updated information is obtained.
• Provide back-up support for distribution and tracking of straggler claims assigned for clean-up and resolution.
• Other duties as assigned.

Education and Experience:

• High School diploma or equivalent

Specialized Skills/Technical Knowledge:

• Knowledge of medical terminology and medical claims preferred.
• Ability to perform effectively in a high-volume, quality-focused work environment.
• Professional communication skills, both verbally and in writing.
• Knowledge of healthcare coding systems and methodologies, including CPT, ICD-10, and DRG preferred.
• Strong organizational, analytical and problem-solving, and follow-up skills.
• Proficiency in Microsoft Office applications, including Word and Excel.
• Ability to learn and effectively utilize workflow management systems, document management platforms, and claim processing applications.