Healthcare Clerk

  • location: Poughkeepsie, NY
  • type: Contract
  • salary: $18 per hour
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job description

Healthcare Clerk

job summary:
Responsibilities:

  • Analyze reports Claims denials. front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy. follow up. time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations. Marketing. Quality etc.. to facilitate the creation of needed job aides. areas of training. member material updates. newsletter updates. etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends. updated training needs. adherence to State reporting guidelines. and communications.
  • Work with the Operations Manager on the Maintenance of Sharepoint communication documents. banner messages. automatic email updates. and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Additional Position Responsibilities ? Optional
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
MINIMUM QUALIFICATIONS

  • An Associate's Degree in a related field Required
  • A Bachelor's Degree in a related field Preferred
  • 3+ years of experience in managed care or health plan focusing on claims processing. reimbursement methodologies and charge systems Required
  • 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Other Government programs experience (Medicare and Medicaid) Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Other Technical writing skills
  • Microsoft Project
  • Microsoft Access
  • Microsoft PowerPoint
  • Microsoft Excel Intermediate
  • Other Familiarity with reporting tools (Crystal. Discovery. etc.)
 
location: Poughkeepsie, New York
job type: Contract
work hours: 8 to 5
education: Associate's degree
experience: 3 Years
 
responsibilities:
Responsibilities:

  • Analyze reports Claims denials. front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy. follow up. time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations. Marketing. Quality etc.. to facilitate the creation of needed job aides. areas of training. member material updates. newsletter updates. etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends. updated training needs. adherence to State reporting guidelines. and communications.
  • Work with the Operations Manager on the Maintenance of Sharepoint communication documents. banner messages. automatic email updates. and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Additional Position Responsibilities ? Optional
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
MINIMUM QUALIFICATIONS

  • An Associate's Degree in a related field Required
  • A Bachelor's Degree in a related field Preferred
  • 3+ years of experience in managed care or health plan focusing on claims processing. reimbursement methodologies and charge systems Required
  • 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Other Government programs experience (Medicare and Medicaid) Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Other Technical writing skills
  • Microsoft Project
  • Microsoft Access
  • Microsoft PowerPoint
  • Microsoft Excel Intermediate
  • Other Familiarity with reporting tools (Crystal. Discovery. etc.)
 
qualifications:
Responsibilities:

  • Analyze reports Claims denials. front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy. follow up. time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations. Marketing. Quality etc.. to facilitate the creation of needed job aides. areas of training. member material updates. newsletter updates. etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends. updated training needs. adherence to State reporting guidelines. and communications.
  • Work with the Operations Manager on the Maintenance of Sharepoint communication documents. banner messages. automatic email updates. and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Additional Position Responsibilities ? Optional
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
MINIMUM QUALIFICATIONS

  • An Associate's Degree in a related field Required
  • A Bachelor's Degree in a related field Preferred
  • 3+ years of experience in managed care or health plan focusing on claims processing. reimbursement methodologies and charge systems Required
  • 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Other Government programs experience (Medicare and Medicaid) Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Other Technical writing skills
  • Microsoft Project
  • Microsoft Access
  • Microsoft PowerPoint
  • Microsoft Excel Intermediate
  • Other Familiarity with reporting tools (Crystal. Discovery. etc.)
 
skills: MS Office
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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