Lead Claims Services Coordinator

Company Overview:

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities:

Acentra Health is looking for a Claims Services Coordinator to join our growing team.

This is a remote position but may require coming onsite to our Tysons' Corporate Office 1 day per week to assist with Mail Duties

Job Summary:

This position is responsible for supporting the Utilization Management process by adhering to

internal policies and procedures and utilizing working knowledge of the organization’s services to

meet productivity and quality standards. The Claims Services Coordinator will work with the

clinical team to perform daily reporting functions necessary for the timely completion of UM

cases.

Responsibilities:

• Act as the main client contact for all claims systems inquiries, reporting, and issues.
• Prepare a daily report of the expiring claims and report to the Program Director if these identified claims cannot be completed timely.
• Coordinate with staff in the Tyson's office to ensure Corrections mail, medical records, and reports are received and retained.
• Report and track all quality concerns (i.e. Incorrect billing) to the client and Program Director.
• Serve as team coach/ mentor to peers on the Claims team

• Develops and maintains working knowledge of internal policies, procedures, and services

  (both departmental and operational).

• Utilizes automated systems to log and retrieve information. Performs accurate and timely data

  entry of electronic faxes.

• Receives inquiries from providers by telephone, email, fax, or mail and communicates

  response within required turnaround times.

• Responds to telephone inquiries in a prompt, accurate, and courteous manner following

  standard operating procedures.

• Interacts with hospitals, physicians, beneficiaries, or other program recipients.

• Performs verification of healthcare services to facilitate payment for received services.

• Identifies medical claims meeting CPT/DRG audit criteria and submits the necessary billing

  data and healthcare records to the third-party auditor.

• Serves as liaison between the client, medical billing coder/ auditor, and external providers.

• Investigates and resolves or reports provider problems. Identifies and escalates difficult

  situations to the appropriate party.

• Meets or exceeds standards for call volume and service level per department guidelines.

• Initiates cases by collecting and entering demographic, provider, and procedure information

  into the system.

• Serves as liaison between the Corrections clinical team and external providers.

• Responsible for the completion of daily, monthly, and quarterly reports necessary for the

  clinical team operations and client reporting.

• Act as the main client contact for all claims systems inquiries, reporting, and issues.
• Prepare a daily report of the expiring claims and report to the Program Director if these identified claims cannot be completed timely.
• Coordinate with staff in the Tyson's office to ensure Corrections mail, medical records, and reports are received and retained.
• Report and track all quality concerns (i.e. Incorrect billing) to the client and Program Director.
• Serve as team coach/ mentor to peers on the Claims team

• Read, understand, and adhere to all corporate policies including policies related to HIPAA

  and its Privacy and Security Rules

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications:

Required Qualifications

• High School Diploma or GED
• 2+ year’s clerical or data-entry work OR 2+ year’s customer service experience in a healthcare or similar environment or industry.
• Proficiency in Microsoft Office suite including the use of Outlook, Word, and Excel applications.
• Effective verbal and listening skills to provide courteous and professional customer service.
• Effective PC skills including electronic mail, intranet and industry standard applications.
• This position may require coming onsite to our Tysons' Corporate Office 1 day per week to assist with Mail Duties

Preferred Qualifications

• Experience with medical billing
• Knowledge of Medical terminology
• Experience with the Health insurance industry
• Medical terminology course(s)
• Ability to work in a fast-paced environment
• Ability to multitask to complete daily required tasks, often in different programs.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range: USD $17.96 - USD $22.45 /Hr.