Job Description
Job Description
JOB-19203 Claims Process Specialist (Claims Processing Analyst-25465)
Work Schedule: M-F 8:30am – 5:00pm (40 Hour Work Week) OR 9:00am – 5:00pm (37.5 Hour Work Week)
Telecommuting: This position may be eligible for telecommuting up to 50% hours scheduled to work in a two (2) week pay period. For new hires, it is typical that the first six (6) weeks of the assignment would be on site, with the possibility of applying for a telecommuting work schedule at that point. All requests are reviewed based on operation need. A laptop and docking station would be provided for remote work use at that time.
Duties:
• Determine appropriate routing for reimbursement of AIHP medical providers;
• Process AIHP Nation pharmacy and vision memberships;
• Support accounts/payable process (key vouchers for AIHP/OHEHR);
• Provide administrative support (minutes, field calls from claims hotline) to AIHP contractors;
• Assist in preparation of periodic reports and analysis;
• Assist in the implementation and maintenance of policies and procedures related to control and processing of payment requests;
• Manage the Unit's workflow, troubleshoot and report to supervisor when necessary;
• Respond to inquiries from providers and Nation billing clerks.
Skills required:
• General/Basic Understanding of the medical claims’ submission process, which includes analyzing Explanation of Benefits (EOB) forms to interpret payment information, ability to read and interpret Medicaid billing schedules and policies, as well as Current Procedural Terminology (CPTs) and Healthcare Common Procedural Coding System (HCPCS);
• General knowledge of automated accounting systems;
• Ability to analyze data and apply basic Generally Accepted Accounting Principles (GAAP) when necessary;
• Proficiency in Microsoft Excel and Word programs;
• Good written and oral communication skills, as well as good organizational skills.
Preferred Skills:
• 2+ years’ work experience as a Medical Coder, Billing Specialist, or equivalent.
Company DescriptionEstablished in 2005, Knowledge Builders Inc. (KBI) offers a wide range of services, including Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling, and Call Center services to organizations of all sizes, including both private companies and governmental entities. KBI is a certified Woman-Owned Business Enterprise (WBE) recognized by New York State, New York City, and the Port Authority of New York and New Jersey.
Our extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country.
We are dedicated to recruiting candidates who consistently exceed our customers’ expectations.
We provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.
Company Description
Established in 2005, Knowledge Builders Inc. (KBI) offers a wide range of services, including Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling, and Call Center services to organizations of all sizes, including both private companies and governmental entities. KBI is a certified Woman-Owned Business Enterprise (WBE) recognized by New York State, New York City, and the Port Authority of New York and New Jersey.\r\n\r\nOur extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country.\r\n\r\nWe are dedicated to recruiting candidates who consistently exceed our customers’ expectations.\r\n\r\nWe provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.