NYC Staffing
divh2Job Summary/h2pProvides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims./ph3Essential Job Duties/h3p Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution./pp Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues./pp Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions./pp Assists in reviews of state and federal complaints related to claims./pp Collaborates with other internal departments to determine appropriate resolution of claims issues./pp Researches claims tracers, adjustments, and resubmissions of claims./pp Adjudicates or readjudicates high volumes of claims in a timely manner./pp Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership./pp Meets claims department quality and production standards./pp Supports claims department initiatives to improve overall claims function efficiency./pp Completes basic claims projects as assigned./ph3Required Qualifications/h3p At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience./pp Research and data analysis skills./pp Organizational skills and attention to detail./pp Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines./pp Customer service experience./pp Effective verbal and written communication skills./pp Microsoft Office suite and applicable software programs proficiency./ppTo all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level./p/div