Healthcare Claims Operations Specialist

1199SEIU Benefit and Pension Funds; New York (NY); On-site; USD 38,000 - 46,000; Full time

Job summary

1199SEIU Benefit and Pension Funds seeks an organized office professional to support the Hospital Claims department. You will maintain accurate data entry for member information in the QNXT system, scan and archive documents into DMS, and handle daily inquiries for timely adjustments.

The role requires at least a high school diploma, clerical experience, and strong data entry skills, with familiarity in Excel/Word and solid written and verbal communication.

Qualifications

• High School Diploma or GED required; some college preferred.
• Minimum two years clerical experience in a general office.
• Basic skill in Microsoft Excel and Word preferred.
• Excellent data entry skills required.
• Knowledge of hospital claims system (QNXT) and eligibility checks.
• Excellent oral and written communication skills.
• Demonstrated organizational skills with ability to multi-task and follow up.
• Problem solver, able to work independently and as a team player

Responsibilities

• Maintain accurate data entry of 199SEIU member information in hospital claims processing system (QNXT)
• Track and ensure completeness of daily inquiries; ensure they are sent to appropriate payment area for adjustment including but not limited to DMS (Data Management System)
• Prepare MSP (Medicare Secondary Payer) claims/rebuttals, scan and archive supporting documents
• Scan and archive documents into DMS (Data Management System)
• Mail and maintain reconsideration letters including maintaining of acknowledgement of reconsideration letters
• Track misdirected provider inquiries received from internal departments within the Fund, enter memo into QNXT and upload document to DMS (Data Management System)
• Handle claim pending with edits for preparation of external transmission files, including review of aged edit(s), retrieval, and assignment of determination of incoming transmission files, follow up, sort and data entry of transmission files related information as needed
• Review and maintain daily utilization management of claims and/or documents to ensure information is accurate and loaded in the claims system are correct, including updating memos and internal tracking logs with determination
• Maintain monthly invoice report to ensure information is accurate and determinations loaded into claims processing system are correct; including updating memos of provider inquiries and medical records received, revised DRG received as well as claims processing/payment information; update internal spreadsheet tracker with claim determination
• Communicate and follow up with external provider and/or vendor via telephone and/or email
• Provide clerical support to the Hospital Claims department including but not limited to handling of mail filing, typing, photocopying, faxing, deliveries, etc.
• Perform additional duties and special projects assigned by management

Skills

Data entry

Communication

Organization

Teamwork

Education

High School Diploma

Tools

Microsoft Excel

Microsoft Word

Job description

1199SEIU Benefit and Pension Funds seeks an organized office professional to support the Hospital Claims department. You will maintain accurate data entry for member information in the QNXT system, scan and archive documents into DMS, and handle daily inquiries for timely adjustments.

The role requires at least a high school diploma, clerical experience, and strong data entry skills, with familiarity in Excel/Word and solid written and verbal communication.