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    Claims Service Correspondent - New York, United States - Metroplus Health Plan Inc

    Metroplus Health Plan Inc
    Metroplus Health Plan Inc New York, United States

    1 month ago

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    Description

    Claims Service Correspondent

    Job Ref: 103312

    Category: Claims

    Department: CLAIMS

    Location: 50 Water Street, 7th Floor, New York, NY 10004

    Job Type: Regular

    Employment Type: Full-Time

    Hire In Rate: $50,000.00

    Salary Range: $50, $55,482.00

    Empower. Unite. Care.

    MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

    About NYC Health + Hospitals

    MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

    Position Overview

    The Claims Service Correspondent is responsible for accurate and timely response to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit.

    Job Description

    • Act as a key liaison and service representative for all written provider inquiries and problem resolution.
    • Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
    • Coordinate and track appropriate problem resolution activities with plan personnel in other departments (ie, Claims, Utilization Management, etc.)
    • Manage and ensure appropriate follow-up and closure for all inquiries.
    • Respond to providers' inquiries in writing and maintain accurate tracking.
    • Data entry into the IMAX system.
    • Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
    • Participate in special projects involving Claim Status Investigations.
    • Resolve Member Bills referred from Member Services.

    Minimum Qualifications

    • High School Diploma required.
    • Minimum 2 years of experience in claims processing protocols and payment schemes.
    • Thorough knowledge of health benefits plans.
    • Must be able to resolve concerns with providers in a professional manner.

    Professional Competencies

    • Integrity and Trust
    • Customer Service Focus
    • Functional/Technical skills
    • Written/Oral Communication
    LI-Hybrid
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