Sauk City, Wisconsin
TAPESTRY Claims Adjuster Specialist Job Opening in Sauk City, Wisconsin - At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company?s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
NTT Data is assisting one of our clients for a temporary assignment. This is an NTT Data badged position. NTT Benefits offered for the duration of the project. Our client is located in Sauk City, WI. The ideal candidate will be local to one of the following locations: Sauk City, WI., Plano, TX., OKC, OK., Nashville, TN., Lincoln, NE., or Bowling Green, KY. Assignment duration is targeted from August 2017 through the end of December 2017, possibly extended beyond.
Job Title : TAPESTRY Claims Adjuster Specialist
Reports to : Supervisor, Customer Relations
Job Summary
The TAPESTRY Claims Adjuster Specialist is responsible for reprocessing of all claim types in the claims processing system, including erroneously paid claims, resubmitted claims and additional charges to previously paid claims. This position is also responsible for the review of high dollar claims to ensure that those claims are paid correctly. Other duties include managing the claim refund request workflow and the reprocessing of all claims associated with claim refund checks. Responsible for adhering to HIPAA and Confidentiality Guidelines. To be considered for this assignment, the successful candidate must have recent TAPESTRY system experience.
Essential Duties and Responsibilities
To successfully perform this job, the individual must be able to perform each essential job function satisfactorily. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions.
70% 1. Reprocess erroneously paid claims, resubmitted claims and additional charges to previously paid claims and log them according to type of error.
Analyze and determine if claim should be reprocessed.
Review and analyze if the Provider check is appropriate.
Review high dollar claims for accuracy and completeness.
Ensure pended claims are processed properly and are paid or denied timely according to established practices and procedures.
Work all reports on a daily basis or upon receipt.
Obtain all information needed to adjudicate claims appropriately through internal and external verbal and written correspondence.
Adhere to the principles of continuous quality improvement to ensure that our members receive the highest quality service.
10% 2. Work with Providers to resolve outstanding refund/recoup issues.
Provide written and verbal communication to the providers to explain the refund/recoup request.
Conduct research on refund/recoup issues to explain why the claim is being refunded or recouped.
Monitor and track outstanding refund/recoup and elevate aging issues to Provider Relations Coordinators and Customer Relations Supervisor.
5% 3. Provide immediate feedback to Customer Relations Supervisor when issues arise that may cause the department to not meet processing or quality goals.
5% 4. Identify trends and opportunities for process improvements, including changes needed to the Claims Manual and Recoveries Manual. Work with supervisor on implementing changes.
5% 5. Meet monthly with the Supervisor, Customer Relations or Manager, Customer Relations to go over questions, address processing issues, and brainstorm to make improvements.
5% 6. Attend weekly set meetings and monthly team meetings and give input. Brainstorm to help make processes more efficient and accurate.
Qualifications
The requirements listed below are representative of the knowledge, skills, and/or abilities required to successfully perform this job.
Education : High School diploma or equivalent.
Experience : Two to three years of health claims processing experience in an automated claims processing environment. Imaging/workflow experience is preferred.
Knowledge, Skills, and Abilities :
Basic skills.
Solid knowledge of personal computer software applications.
Above average verbal and written communication skills.
Excellent interactive skills with other employees.
Manage multiple projects simultaneously and complete timely.
Meticulous, well organized, responsible, helpful, conscientious and prompt.
Very reliable in terms of attendance and punctuality.
Ability to work under close supervision while working independently and exercising good judgment.
Excellent data entry skills.
Excellent skills required.
Proficient math aptitude.
Remain professional under pressure and be adaptable to change.
Work effectively with external vendors, providers and payers.
Ability to work seasonal overtime as business necessitates.
Job Type: Temporary
Required education:
High school or equivalent
Required experience:
claims processing: 2 years
Tapestry system: 1 year
high dollar claims processing: 1 year
reprocessing of all claim types: 1 year
COB: 1 year
claims auditing: 1 year
enrollment: 1 year
|
