Sr Reconciliation Representative (Remote - $17/hr)

American Specialty Health Incorporated (ASH) is seeking a Senior Reconciliation Representative to join our Reconciliation department. This role focuses on reconciling complex claims for payment based on Explanation of Benefits from Health Plan Payors for 2-step accounts.

About the role

This is a remote position. Training will be conducted remotely, and you must be able to work from home (WFH) in a designated work area using company-provided technology equipment. A stable internet connection with a minimum speed of 50 Mbps download / 10 Mbps upload is required (100 down / 20 up recommended for 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 via paper EOBs or spreadsheets.
• Contacts Health Plans to check claim status, including payment or underpayment, and requests reprocessing if claims are denied in error.
• Uses Health Plan and TPA websites to check 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 and spreadsheets.
• Reviews and responds to ASHCore logs within 48 hours of the assigned date.
• Meets department production and quality requirements.
• Maintains confidentiality of all claims documents, records, and related issues.
• Promotes cooperation and understanding among all personnel.
• Attends organizational and department meetings as required.
• Adheres to organizational policies and procedures.
• Identifies unique or problematic situations and researches recommendations for supervisors.
• Provides assistance and teamwork to Claims Department staff for routine duties and special projects.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

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

Skills

• Excellent listening and interpersonal communication skills to identify critical core competencies.
• Ability to interact positively and respectfully to establish and maintain cooperative working relationships.
• Strong customer service skills to meet the needs of internal and external customers.
• Ability to organize, prioritize, multitask, and manage time effectively.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Ability to analyze information, problems, issues, and procedures to develop effective solutions.
• Ability to maintain strict confidentiality in all matters.

Mobility & Physical Requirements

• Primarily sedentary; able to sit for long periods.
• Ability to see, speak, and hear other personnel and/or objects.
• Ability to communicate verbally and in writing.
• Capable of using a telephone, computer keyboard, and mouse.
• Ability to lift up to 10 lbs.
• Ability to travel within and around the facility or work-from-home (WFH) environment.