Sr Reconciliation Representative (Remote - $17/hr)

American Specialty Health Incorporated; San Diego (CA); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Company-provided equipment

Remote work from home

Job summary

American Specialty Health Incorporated (ASH) is seeking a Sr Reconciliation Representative to join our Claims department. The role focuses on reconciling, resolving, and researching 2-step claims for payment per EOBs from Health Plan Payors.

The position supports remote work from home with company-provided equipment and requires strong accuracy, communication, and collaboration within the Claims team.

Qualifications

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

Responsibilities

• Reconciles, resolves, and researches 2-step claims and payments to ASH.
• 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 claim status or reconcile claims.
• Maintains confidentiality and meets department production and quality requirements.

Skills

Customer service

Interpersonal communication

Attention to detail

Time management

Teamwork

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

Description

American Specialty Health Incorporated (ASH) is seeking an Sr Reconciliation Representative to join our Claims department.

The primary function of this position is to reconcile claims, including complex claims, for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.

Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Responsibilities

• Reconciles, resolves, and researches 2-step claims and payments to ASH.
  • 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 which may include payment or underpayment. In addition will request claims to be reprocessed if denied in error.
  • Uses Health Plan and TPA websites to check on claim status or reconcile claims.
  • Reconciles claims from various reports including but not limited to 14 day reports, aged reports, unreconciled reports, and rejected reports.
  • Notifies supervisors of trends related to invalid denials by TPAs or Health Plans.
  • Documents comments in internal notes fields in IHIS in addition to spreadsheets being worked.
  • Reviews and responds to ASHCore logs within 48 hours of assigned date.
  • Meets department production and quality requirements.
  • Maintains confidentiality of all claims documents, records, and claims related issues.
  • Promotes a spirit of cooperation and understanding among all personnel.
  • Attends organizational meetings and trainings as required.
  • Attends department meetings.
  • Adheres to organizational policies and procedures.
  • Recognizes unique and/or problem situations within area of assigned responsibility. Researches and makes recommendations to Supervisor.
• Provides assistance and teamwork to Claims Department staff in accomplishment of routine duties and special projects.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• 2 years with claims processing, computer, typing, 10-key, and telephone skills preferred.
• Knowledge of Microsoft Word and Excel helpful.
• Familiarity with Managed Care, HMO, PPO health plan provisions.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCPhere.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at .

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