Here's what you'll be doing: Re-price Contract Health Services/Purchased Referred Care eligible claims to the

MLR /PRC

for hospital and physicians for both internal and external clients; re-price employee health claims in their designated PPO software portals; assists in the production and distribution of benefit information to members employees and clients Maintains database of facility CMS Rate Notifications letters and submits to data vendor as needed to ensure accurate re-pricing; updates and maintains Section 506 Recovery reimbursement data via excel spreadsheets Prepares and compiles documents for stop-loss and Catastrophic Health Emergency Fund reimbursements; updates and inputs pre-certifications and authorizations into claim adjudication Identifies documents for destruction, maintains destruction schedule and verifies documents are destroyed on site by document destruction vendor; prints and distributes daily reports and all letters generated by claims examiners Answers incoming customer service calls, manages departmental mail posting, sorting and distribution; assists walk-in customers promptly and courteously Assists Accounting Specialist with in-house check runs and creates departmental purchasing requisitions for the Director's approval; types letters, reports, memos and create flyers as requested by supervisor Here's what you'll need to be successful: High school diploma or GED Two (2) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred Must obtain and maintain HIPAA and Insurance Marketplace CAC certification Knowledge of medical terminology and health/medical insurance Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint Ability to communicate effectively and represent organization in a professional manner Must successfully pass all applicable background checks and drug screens Preferred qualifications: Four (4) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred Experience with Indian Health Service preferred Benefits you'll love: Approximately 5 weeks of paid time off annually 3 weeks of paid holidays Premium free health insurance Flexible spending accounts Short term disability Life insurance 401k with match Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.