at Highmark Health in

Springfield, Illinois, United States Job Description Company :

Highmark Inc.

Job Description :

Duties Note:

The following is not intended to be an exhaustive list of all duties required of this position. ADA E1. Ensure all claims are handled according to all internal operating and administrative procedures along with reviewing plan wording for each individual employer group, which should include the plan document, amendments, matrices and benefit summary. E2. Monitor workflow of audits to ensure timely turnaround time. Identify the performance guarantee group's audits to meet the strict guidelines for turnaround time. E3. Maintain workload in accordance with the quality and production standards defined for the auditing team. E4. Record results in the audit tool for monthly reporting. Partner with the supervisor to create and conduct training sessions for issues identified by the management team. E5. Conduct one on one coaching with the claims team especially the trainee staff E6. Provide recommendation for dollar authorization for claims team members based on audit stats and interaction with individual claim team members. E7. Assist supervisor with specialized audits for the SOC process, carrier, vendor and employer audits as necessary. E8. Maintain detailed knowledge of benefits, state regulations, federal guidelines and system upgrades. E9. Review and provide expertise to the claims team with complex claim situation/issues by using all resources to render a sound decision. E10. Utilize excellent written or verbal communication skills to liaise with clients, management, peers and other areas within the organization E11. Manage the refund, void and stop payment process E12. Provide guidance to the claims team with questions on all aspects of claims processing. E13. Assist with system upgrade testing. N14. Handle other duties as assigned

Education/Experience/Skills Requirements Required Education:

HS/ GED :

Required Experience:

5 years prior medical dental, vision, FSA and HRA claims processing experience.

Preferred:

Associate Degree Required Knowledge/Skills:

1. Comprehensive understanding of

CPT , HCPCS

, ICD9 and ICD10 medical coding 2. Strong attention to details along with organizational skills 3. Excellent problem solving with the ability to work in a fast paced production environment 4. Excellent communication skills both verbal and written 5. PC navigation skills for Professional work environment 6. Basic MS Excel 7. Basic MS Word 8. Ability to use judgement to make To view full details and how to apply, please login or create a Job Seeker account