Sr Reconciliation Rep (Remote, $17/hour)

American Specialty Health Incorporated is seeking a Sr Reconciliation Representative to join our Reconciliation department. This position will reconcile claims, including complex claims, for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.

Remote Worker Considerations:

Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.

Remote Worker Considerations

Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).  

Responsibilities

• Reconciles, resolves, and researches 2-step claims and payments to ASH.
• Manually reconciles claims for payment from Health Plan Payors received by paper EOBs or spreadsheets.
• Makes calls to Health Plans to check status of claims which may include payment or underpayment. In addition will request claims to be reprocessed if denied in error.
• Uses Health Plan and TPA websites to check on claim status or reconcile claims.
• Reconciles claims from various reports including but not limited to 14-day reports, aged reports, unreconciled reports, and rejected reports.
• Notifies supervisors of trends related to invalid denials by TPAs or Health Plans.
• Documents comments in internal notes fields in IHIS in addition to spreadsheets being worked.
• Reviews and responds to ASHCore logs within 48 hours of assigned date.
• Meets department production and quality requirements.
• Maintains confidentiality of all claims documents, records, and claims related issues.
• Promotes a spirit of cooperation and understanding among all personnel.
• Attends organizational meetings and trainings as required.
• Attends department meetings.
• Adheres to organizational policies and procedures.
• Recognizes unique and/or problem situations within area of assigned responsibility. Researches and makes recommendations to Supervisor.
• Provides assistance and teamwork to Claims Department staff in accomplishment of routine duties and special projects.

Qualifications

• High School diploma or GED required.
• 2 to 3 years with claims processing, computer, typing, 10 key and telephone skills preferred.
• Knowledge of Microsoft Word and Excel helpful.
• Familiarity with Managed Care, HMO, PPO health plan provisions.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. 

Environmental Conditions

Work-from-home (WFH) environment.

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