Johnson Service Group (JSG) is seeking a Claims Member Billing Representative. This is a 3 month+ temporary position. Fully remote.
Monday-Friday- Must work PST hours
Pay rate: $22.00 per hour. Overview:
Process Direct Member Reimbursement claims accurately and in a timely manner, meeting established department and company guidelines for quality, turnaround time and accuracy. Assists Member’s in collecting required claim information through communication with the Member and Provider. Claims processing delays due to missing information is frequently unexpected and not understood by the Member creating concern. Appropriate handling of direct member reimbursement claims build trust between the Member and Company. Job Functions:
Review and evaluate claims for completeness and collect required information as needed by connecting with members and/or provider. Establish rapport with Member and Provider to gather all information required for evaluating the claim.
Oversight and follow up with ancillary vendors and providers to ensure appropriate claim adjudication and member payment in accordance with benefit coverages and regulatory timelines.
Determine level of reimbursement based on established criteria and/or plan provisions.
Generate appropriate member denials based on established departmental guidelines and training. Ensure corresponding denial letters are accurate.
Reviews vendor denials for appropriateness and makes determinations regarding special coverage circumstances.
Document all non-standard processes in the claim notes.
Identify and report adjudication inaccuracies that are related to system configuration, benefit inconsistencies, and fee schedules.
Consistently meet individual performance metrics to ensure department quality and productivity standards are met.
Work assigned cases through company workflow system, apply correct status attributes to track and trend issues. Notate cases with required detail to ensure that others understand status of case and final resolution.
Follow policies and procedures in order to maintain efficient and compliant operations; communicate suggestions for improvement and efficiencies to management; identify and report problems with workflows following proper departmental procedures; and actively participate in departmental staff meetings and training sessions.
Provide a high level of customer service to members, providers, as well as internal customers by consistently meeting and/or exceeding team expectations including but not limited to quality, productivity and attendance.
Increase member satisfaction and retention by following up and resolving member balance bill issues, complaints and question in an efficient, timely and accurate fashion; coordinate resolution with providers and other departments as needed.
Escalate appropriate member issues to management or other departments as required and following departmental and organizational policies and procedures.
Follow all appropriate Federal and State regulatory requirements and guidelines applicable to Company Health Plan operations or as documented in company policies and procedures.
Contribute to overall department success by participating in department initiatives, effective communication and collaboration with all members of the company team through knowledge and idea sharing, take ownership to identify and report issues to appropriate management staff for resolution and work actively with the company team to improve the support to our Members and Providers.
Contribute to team effort by accomplishing related results as needed.
Actively support the achievement of company Vision and Goals.
Other duties as assigned.
JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.
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