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Claims Processing Specialist - Full Time Days - Immanuel Home Office

Immanuel Omaha, NE
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Job Description

Purpose of the Job: 

The overall purpose of the job is to perform the claims processing functions that support Immanuel’s Pathways business.  The responsibilities of the job include receiving, reviewing, and adjudicating Pathways claims received from contracted and non-contracted outside providers.  This process will include the verification that a valid order was written for the service along with the required requisition and that the appropriate medical records have been received and recorded in the Electronic Medical Records System.  This position is responsible to fielding all inquiries with regard to the status and payment of all claims.  This position will support and live out Immanuel’s Mission and CHRIST Promises.

KEY RESPONSIBILITIES

Key Areas

Key Responsibilities and Duties of the Job

Adjudication of Claims

  • Reviews, adjudicates, and processes payments of the participants’ expenses for Immanuel Pathways-PACE, ensuring that all charges agree with the contract terms. 
  • Adjudicates all claims in Mediture, ensure all payouts are calculated based on related fee schedule for vendor. Requires understanding of fee schedules, denials, and coding.

Claims Processing

  • Scans and get approval from Center personnel as needed for invoices.
  • Enters all claims into Mediture.
  • Transmits Mediture claims to accounting software for payment.
  • Coordinates with Accounts Payable for check processing of claims and printing of Explanation of Payment (EOP).
  • Processes claims presented electronically by vendors.
  • Processes all denials and appeals for claims.
  • Fields inquiries from vendors for authorization for services, claims payments and issues.
  • Follows up with vendors for past due invoices.
  • Assists with maintaining provider database in Mediture.
  • Coordinates with hospital admissions for authorizations for inpatient stays.
  • Processes and correct Electronic Data Systems (EDS) failures.
  • Understands and works at maintaining orders and requisitions process.
  • Maintains files of all paid claims.

Other

  • Opens and sorts all mail relating to Pathways claims.
  • May assist with training new employees in processes and procedures.
  • Contributes to ways of improving work flow process.
  • Performs other duties as assigned or requested.

QUALIFICATIONS

Education-

  • Associates Degree in Accounting, Business, or a related field is preferred.
  • Equivalent years of experience may substitute for education requirement.

Experience-

  • Two (2) years of experience in medical claims processing is required.  Experience in a health care or hospital setting is desirable.
  • Equivalent years of education may substitute for experience requirement.

KSA- Knowledge Skills and Abilities -

  • Knowledge of basic Accounting principles.
  • Knowledge of medical claims processing and practices.
  • Knowledge of Medicare and Medicaid programs and/or how to research government websites to find information.
  • Skilled in data and information management.
  • Strong mathematical skills with attention to detail and accuracy.
  • Ability to complete assigned work on time.
  • Ability to manage multiple priorities.
  • Ability to utilize critical thinking, analytical, and problem solving skills.
  • Strong computer skills in Microsoft Office, including Excel, Word and Outlook and the ability to learn and use various software programs.
  • Ability to work independently, meet deadlines, and multi-task while maintaining quality standards.
  • Ability to develop specific goals and plans to prioritize, organize, and accomplish job duties.
  • Customer service skills.
  • Ability to work in a team environment.
  • Ability to communicate effectively both verbally and in writing with individuals at all levels in the organization.
  • Ability to communicate with external business contacts in an articulate, professional manner while maintaining the necessary degree of confidentially.
  • Ability to comply with established policies and procedures.

Job Details

Date Posted August 14, 2017
Date Closes November 30, 2017
Located In Omaha, NE
Job Type Full-time Employee
Hours 40 hours per week
Positions Available 1
SOC Category 43-9041.00 Insurance Claims and Policy Processing Clerks
Zipcode 68154
Name Traci Soliz
Address 1044 N 115th Street, Suite 500
City, State and Zip Omaha, NE 68154

This job offers the following benefits

  • 401(k) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • Dental
  • Dependent Life Insurance
  • Employee Assistance Program (EAP)
  • Group Legal
  • Life Insurance
  • Long-Term Disability
  • Medical
  • Prescription Drug Plan
  • Short-Term Disability
  • Vision
  • Voluntary Life Insurance
  • Adoption Assistance
  • Bereavement Pay
  • Continuing Education Program
  • Discounts on Employer Merchandise & Services
  • Employee Referral Program
  • Fitness Classes
  • Free Parking
  • Paid Holidays
  • Paid Vacations
  • Tuition Reimbursement
  • Wellness Program
  • Workout Facilities
  • Merit Increases
At a Glance
Enjoy these benefits
  • 401(k) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • And More ...
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