Job description
The Claims Support Specialist provides support to the health plan members, providers and third party adjudicator to ensure understanding of the application of benefits and accuracy, timeliness and appropriateness of claims payments. This position is full-time, Mon-Fri, 8a-4:30p, reporting to our Syracuse Office.
Performance Responsibilities and Standards:
Receives, responds to and/or records inquiries from members, providers, and other consumers related to areas of coverage and payment of claims for Medicaid and Medicare plans.
- Works directly with TPA to resolve authorization, contract and eligibility issues.
- Collaborates with other health plan departments and vendors to ensure claims are processed in accordance with agency established guidelines and/or policies and procedures.
- Conducts regular review of claims based on plan needs.
- Documents and communicates issues related to claims adjudication to supervisor in a timely manner.
- Provides assistance and guidance consistent with agency policies and procedures to members and providers related to billing and payments.
- Actively participates in performance improvement and continuous quality improvement (CQI) activities.
- Ensures adherence at all times to all applicable department and professional standards, to include HIPAA and Privacy requirements.
- Provides courteous, responsive, respectful and knowledgeable customer service.
- Performs other duties as assigned.
Requirements:
- High School Diploma or equivalent required.
- Skilled in prioritizing, problem-solving, multi-tasking, and meeting deadlines.
- Insurance experience. Understanding of Medicare benefits a plus.
- Exceptional customer service skills.
- Demonstrates discretion in handling confidential and sensitive information
- Excellent communication skills, verbal and written.
Physical Requirements:
- Speaking/visual/hearing ability sufficient to comprehend and express written/verbal communication.
- Extended periods of computer use.
- Ability to sit or stand at a desk 90% of the day
- Bloodborne Pathogens Exposure Category III – Employee who rarely has contact with blood and body fluids.
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About Nascentia Health
Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.
Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.
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Nascentia Health is an Equal Opportunity Employer (EOE)
Employment is contingent on negative results of a new hire drug screen.
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