Summary of Responsibilities:
Opens, sorts and distributes incoming mail via electronic workflow system for the Benefits department. Applies the correct indexing schema to each document, assigning member number, name, document type and workflow folder. Associate must make decisions on a daily basis and select most appropriate document type and workflow folder for uncommon documents based on reading the content.
Creates and maintains all healthcare provider records in the Facets claim processing system. Associate must make decisions on a daily basis to match existing provider records or to create a new record. Discretion is given to the associate to select the correct place of service, specialty, type and provider credentialing from three or more source references. The objective is to build a complete accurate record using multiple source documents of varying quality. Assigns user warning workflow messages for proper routing and plan coverage.
Associate must be flexible and appropriately shift priorities several times each week based on the volume of mail and Facets new providers.
Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis.
Opens, sorts, scans and indexes mail to appropriate folders with correct document types within established time service and quality guidelines.
Ensures images are of highest imaged quality. In cases where images are not clear, Clerical Assistant will delete and rescan.
Ensures that all documents are indexed correctly according to the appropriate document type and workflowed to the correct department staff.
Reviews, matches or creates provider file records in the Facets medical claim processing system within the established time service and quality guidelines.
Ensures that provider records are of the highest quality for proper payment and benefit processing. In cases of record discrepancies, the Clerical Assistant will review and call providers for correct provider record content.
Provides excellent customer service to internal customers to include answering questions on images, documents, rescanning or reindexing the documents and correcting provider records per department associate request.
Prioritizes the daily workload to meet needs of various department personnel.
Reconciles discrepancy error reports, and checks workflow error queues daily. Researches and corrects error documents/workflow to remove from discrepancy reports.
Handles additional tasks such as returning incomplete claims accurately and efficiently, monitors the destruction of confidential records, sorts and distributes daily output to accurate mail slots, maintains departmental files, transfers files to storage according to established schedules and makes copies for Appeals Committee.
Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality and protection of personal information, including, but not limited to, personal health information and personally identifiable information.
Performs any additional work as required by management.
Demonstrated strong attention to detail with excellent organizational skills. Must cite examples of organization and time management methods used to manage or prioritize workload demands.
Proven examples from work experience of maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties.
Demonstrated strong verbal and written communication skills with ability to convey information to internal and external customers in a clear, accurate, focused and concise manner. Demonstrated ability to document activities in a manner that is understandable to others and prepared using a prescribed format. Has a strong use of the English language to include proper application in both verbal and written format of the elements of grammar, punctuation, diction and spelling proficiency.
Demonstrated experience working effectively within a team. Must provide examples of motivating co-workers in difficult situations.
Proven examples of consistently meeting productivity and quality goals from work experience.
Proven experience handling confidential information in a discreet manner.
Works in an office setting and remains continuously in a stationary position for long periods of time while working at a desk, on a computer, with other standard office equipment, or while in meetings.
Requires visual acuity to read a variety of correspondence, reports and forms and to prepare and analyze data in an accurate, neat and thorough manner.
Performs continous keyboarding work requiring the ability to make repetitive motions of the wrists, hands and/or fingers.
Frequently moves around the office to access file cabinets, office machinery, etc. While accessing file cabinets, frequently uses upper extremities to reach by extending hands and/or arms in any direction.
Computer Skills and Knowledge of Hardware & Software required:
Certifications & Licenses (i.e., Series 6 & 63, CPA, etc.):
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