Managing the workflow to ensure client performance standards are met, including providing technical assistance to processors, identifying system related issues, providing feedback on audit errors, and performing remedial training.
Run claims aging reports and route claims queues to claims processors, daily. This includes examining queues to determine that work is assigned based on processor experience and account performance expectations for turn around time.
Respond to processor adjudication and claims process questions throughout the day. Advise processors on the calculation of complicated payment rates, payment of inpatient claims, etc.
Review daily audit results prior to distribution to staff. Identify quality issues and trends that impact individual performance and review audit results with staff, daily. Refer errors that require an audit appeal to the Supervisor, daily.
Provide individual remedial training to staff based on audit results and advise the supervisor of any classroom training needs identified in the remedial training process. Document all individual training initiatives for the supervisor and manager.
Work closely with the Account and Provider Liaisons to insure expedited/priority claims are assigned and adjudicated appropriately.
Advise the Supervisor of any policies and procedures needed to support the unit and work closely with the Audit Department to identify any process, procedure, BOL, Phoenix or system issues that impedes the units opportunity to meet quality performance measures
Ensure that client performance guarantees are met and communicate with supervisory and management staff if there are indicators that guarantees will not be met.
Compile client specific performance reports, as required.
Education: BS preferred
- Relevant Work Experience: 2-4 years claims processing experience preferred.
Value Options - 17 months ago
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