Sr. Reconciliation Representative

San Diego, CA 92121

Post Date: 04/04/2018 Job ID: 42365 Profession: Accounting
For over twenty years, we have been able to offer exceptional health care plans to people of all ages, backgrounds, and life circumstances. As an organization our mission is to empower individuals to live longer and healthier lives.A friendly and reliable Reconciliation Representative would be the ideal candidate for our organization.
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.
Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
Ability to effectively organize, prioritize, multi-task and manage time.
Demonstrated accuracy and productivity in a changing environment with constant interruptions.
Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
Ability to exercise strict confidentiality in all matters.The primary function of this position is to reconcile claims, including complex claims, for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.
Detailed Duties and Responsibilities
Essential Functions:90% Reconciles, resolves, and researches 2-step claims and payments to ASH.
System reconciles ASO claims payment from Health Plan Payors.
Makes calls to Health Plans to check status of claims which may include payment or underpayment.
Make courtesy calls to Providers as needed.
Makes calls and researches overpayment requests from health plan recovery services.
Documents follow-up in reconciliation system or communication log (ASHCore).
Prepares letters of explanation to Health Plans and prepares spreadsheet documentation of claims disposition/payments/overpayments/underpayments.
Completes check requests for reimbursements of overpayments to Health Plans.
Maintains confidentiality of all claims documents, records, and claims related issues.
Promotes a spirit of cooperation and understanding among all personnel.
Attends organizational meetings as required.
Adheres to organizational policies and procedures.
Recognizes unique and/or problem situations within area of assigned responsibility. Researches and makes recommendations to Supervisor.
5% Provides assistance and teamwork to Claims Department staff in accomplishment of routine duties and special projects.5% Performs other duties and responsibilities as assigned.
What we need from you:
High school diploma
2 to 3 years with claims processing, computer, typing, 10 key and telephone skills preferred.
Knowledge of Microsoft Word and Excel helpful.
Schedule: Monday-Friday 5am-6pm (depending on shift availability)
Benefits: Amazing Benefits at a low cost
Health Insurance Dental PTO Paid Holiday
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