Reconciliation Representative (Onsite - San Diego, CA)

Responsibilities

• Reconciles, resolves, and researches 2-step claims and payments to ASH.
• Receives and sorts incoming mail including paper EOBs, faxes, Interoffice Mail, and Health Plan letters.
• Downloads electronic EOBs from Health Plan Portals.
• Counts and scans EOBs and Health plan letters for distribution and tracks 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 which may include payment or underpayment.
• Requests 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, MO copay, fee schedule 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.
• 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 and responsibilities as assigned.
• Complies with all policies and standards.

Qualifications

• A High School Diploma or GED certificate required.
• 2 years with claims processing, computer, typing, 10-key, and telephone skills required.
• 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.
• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Demonstrated 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 lift up to 10 lbs.
• Environmental Conditions: Usual office setting.