The Accountable Care Department is responsible for producing and managing information that assists healthcare providers in ensuring that the right care gets to the right patient at the right time. Currently, the department is responsible for working with specific Medicare Advantage, Medicaid, and Commercial populations to aid in this effort.
This position designates a working point person to coordinate internal stakeholders, claims adjudicators, and support staff. They are responsible for ensuring timely and accurate processing of hospital and professional medical claims for the membership serviced through the Accountable Care Department.
1. Subject matter expert for Apple Health, Health Care Authority, and Molina billing guidelines, and advises claims processing team and system support analysts in accordance.
2. Manage staff case loads and provide appropriate direction as needed.
3. Creates and maintains policies and procedures; informs and instructs staff as to proper policy and procedure and follows up to ensure desired results.
4. Accurately apply new knowledge or changes to current regulations and techniques to current processes to help improve productivity and accuracy.
5. Provide effective two-way oral and written communication with all co-workers and interested parties so that everyone understands the issues, how they are to be resolved, and understand the expectations for future follow-up.
6. Remain calm, patient, and reasonably unaffected while working under pressure and stress.
7. Serves as a liaison between staff and management team.
8. Pro-actively research guidelines and regulations.
9. Use sound judgment to help resolve situations
10. Other duties as assigned.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
· 3 years of medical/hospital claims processing experience.
· Possesses intermediate computer skills (e.g., spreadsheets, word processing); knowledge of MS Office preferred.
· Bachelors Degree or equivalent experience.
· Professional Medical (CPC) and/or Hospital (CPC-H) coder certification.