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CLAIMS COORDINATOR - HOAG CLINIC CLAIMS & ENROLLMEN

Department:  Business Services
Status:  Full Time
Shift:  1st

Job Summary: The Claims Coordinator is responsible for pre-screening and batching correspondences received in the Hoag Clinic MSO mailroom. The Claims Coordinator will coordinate the hand-offs and completions of retro-auth requests, provider update requests, and eligibility verification requests between the Claims team and internal and external partners.

 

Essential Functions

· Support the claims department by preparing claim receipts and correspondences received in the Hoag Clinic MSO mailroom

· Track mailroom claim receipts and assist in the paper claims OCR scanning into electronic format

· Ensure all documents are accurately counted, date stamped, tracked, and reconciled

· Assist with daily pick-ups and distribution of mail and correspondences from dedicated post office boxes, fax machines, e-fax, secure file transfers, as well as sending provider EOBs, member letters, misdirected claims, and other letters sent by the Claims team

· Meet Hoag Clinic MSO quality and timeliness requirements in handling claims and correspondences in accordance with regulatory and health plan requirements

· Assist in identifying and reporting issues working with the Claims management team to develop procedures and workflows to ensure efficient mailroom processes

· Interact in a positive and collaborative manner with internal and external partners

· Support the claims team in implementing initiatives in improving claims processing efficiency

· Assist in provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary based on team guidelines

· Perform other duties as assigned

 

Education, Training and Experience Required: High School Diploma or equivalent, 1 year of experience in a healthcare environment, environment, knowledge of HMO/managed care regulatory guidelines Preferred: Experience with Epic Tapestry system. 2 years Claims mailroom experience, OCR processing Skills or Other Qualifications Required: Strong moral compass and commitment to Hoag’s values Motivated to learn, continually improve and operate to one’s fullest potential Positive attitude, passionate, excited, strong desire to simplify processes. Experience in providing excellent customer service, empathetic ability Skills to multi-task and manage competing priorities, apply critical thinking to solve problems Tech savvy and posses a capability to quickly learn new applications Ability to maintain composure and compassion while addressing a high volume of competing tasks Comfortable with ambiguity and open to collaborative environments Microsoft Word, Excel, Typing/Data Entry Preferred: License and Certifications Required: Preferred:

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