The 1199SEIU Benefit & Pension Funds provide comprehensive health, pension, and quality of life benefits to unionized workers represented by 1199SEIU United Healthcare Workers East. We are among the largest labor-management funds in the nation, covering 400,000 members and their families.
If you're ready for the brightest career future, join us in this excellent opportunity to showcase your talents. We are currently seeking an experienced Medical Claims Coordinator for our Medical Claims department.
Responsibilities
- Assist Manager and Supervisors in coordinating, distributing and finalizing Medicare Secondary Payer (MSP) and Office of Medicaid Inspector General (OMIG) Medicaid Claims
- Verify member eligibility, review, organize and confirm essential documentation for medical claims is appropriate
- Communicate (oral and written) with various government agencies, third party entities, employers, members, providers and other Fund departments regarding medical claims
- Create and prepare spreadsheets, maintain statistical analysis and prepare data for program reports and presentations
- Track and manage timely responses to ensure Demand Letter deadlines are achieved
- Research, plan, implement and train staff on new MSP workflow process initiatives to meet changing needs of the Funds
- Calculate and re-price J codes and drug pharmaceutical claims
- Audit and review finalized medical claims to determine if interest payments are appropriate
- Coordinate the reconsideration process and work with manager/supervisor, and staff resolving reconsideration process inquiries
- Perform additional duties and projects as assigned by management
Qualifications
- Associate's degree or equivalent years of experience required; plus
- Minimum three (3) years Medical Claims experience as a Quality Control Reviewer or Medical Claims Auditor in a health insurance or benefits environment required
- Thorough knowledge of medical claims processing systems and health plan processes required
- Intermediate skill level in Microsoft Word and Excel preferred; able to utilize basic Web browsers and conduct searches
- Extensive knowledge of medical claims processing and terminology (CPT, ICD-9 and HCPCS codes), third-party reimbursement, coordination of Benefits (COB), and Medicare Secondary Payer (MSP)
- Strong interpersonal and group facilitation skills, ability to multitask, problem solve, troubleshoot and work in a fast paced team environment
- Excellent verbal and written communication skills; highly organized self-starter
- Able to complete assignments and meet time sensitive deadlines
- Must meet performance standards including attendance and punctuality
