Reconciliation Representative (Onsite San Diego, CA)

American Specialty Health Incorporated (ASH) is seeking a Reconciliation Representative to join our Claims department.

The primary function of this position is to reconcile claims including complex claims for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.

Responsibilities

• Reconciles resolves and researches 2-step claims and payments to ASH.
  • Receives and sorts incoming mail including paper EOBs faxes Interoffice Mail and Health Plan letters.
  • Downloads electronic EOBs from Health Plan Portals.
  • Count and scan EOBs and Health plan letters for distribution and track counts into daily inventory.
  • Manually reconciles claims for payment from Health Plan Payors received by paper EOBs or spreadsheets.
  • Makes calls to Health Plans to check status of claims which may include payment or addition will request claims to be reprocessed if denied in error.
  • Uses Health Plan and TPA websites to check on claim status or reconcile claims.
  • Reconciles claims from various reports including but not limited to 14-day reports MO copay fee schedule reports unreconciled reports and rejected reports.
  • Notifies supervisors of trends related to invalid denials by TPAs or Health Plans.
  • Documents comments in internal notes fields in IHIS in addition to spreadsheets being worked.
  • Meets department production and quality requirements.
  • Maintains confidentiality of all claims documents records and claims related issues.
  • Promotes a spirit of cooperation and understanding among all personnel.
  • Attends organizational meetings and trainings as required.
  • Attends department meetings.
  • Adheres to organizational policies and procedures.
  • Recognizes unique and/or problem situations within area of assigned responsibility. Researches and makes recommendations to Supervisor.
• Provides assistance and teamwork to Claims Department staff in accomplishment of routine duties and special projects.
• Performs other duties and responsibilities as assigned.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• 2 years with claims processing computer typing 10-key and telephone skills required.
• Knowledge of Microsoft Word and Excel helpful.
• Familiarity with Managed Care HMO PPO health plan provisions.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

Core Competencies

• Demonstrated ability to interact in a positive respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize prioritize multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information problems issues situations and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary able to sit for long periods of time.

Physical Requirements

• Ability to see speak and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone computer keyboard and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy childbirth related medical conditions breastfeeding and reproductive health decision-making) gender gender identity gender expression race color religion (including religious dress and grooming practices) creed national origin citizenship ancestry physical or mental disability legally-protected medical condition marital status age sexual orientation genetic information military or veteran status political affiliation or any other basis protected by applicable local federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCPhere.

If you are a qualified individual with a disability or a disabled veteran you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation contact our Human Resources Department at x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about discussed or disclosed their own pay or the pay of another employee or applicant. However employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information unless the disclosure is (a) in response to a formal complaint or charge (b) in furtherance of an investigation proceeding hearing or action including an investigation conducted by the employer or (c) consistent with the Companys legal duty to furnish information.

#LI-Remote #Claims #Process #Reconcile #Data #Dataentry #10key #Healthcare