Balance Billing Coordinator - 1199seiubenefits : Job Details

Responsibilities

·Negotiate and resolve large volume of balance billing inquires, negotiate fees and discounts for members with non-participating providers to reduce out of pocket expenses;

·Communicate via telephone and written correspondence with providers, members, attorneys, or collection agencies to resolve balance billing/fee negotiation inquiries to completion; handle large call volume in reference to balance billing inquiries

·Analyze received correspondence; verify member eligibility, claim history and coordination of benefits

·Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover monies

·Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices

·Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner

·Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network

·Educate members and providers with out of network fees, out of pocket expenses and benefits of using the Funds network

·Perform additional duties and projects as assigned by management

Qualifications

·High School Diploma or GED required, some college or college degree preferred

·Minimum two (2) years experience processing medical professional and facility hospital claims preferred

·Experience negotiating bills and payments for managed care plans preferred

·Knowledge of provider contracts and collections processes preferred

·Excellent knowledge of health claims, eligibility rules, Coordination of Benefits (COB), 1199SEIU Benefit and Pension Fund and Retiree Benefits;

·Knowledge of Current Procedural Terminology(CPT) codes, andInternational Classification of Diseases(ICD-10) codes preferred

·Knowledge of health claims processing and benefit administration systems (QNXT and Vitech V3) preferred

·Familiar with provider databases, web-based applications and call tracking systems (i.e. Cactus, IObserver, BeneFAQs, Member and Provider Portal)

·Strong, analytical, and problem solving skills; able to work well independently and in a team oriented environment

·Basic skill level in Word, Excel and Access required

·Outstanding customer service skills; ability to maintain a pleasant attitude and provide excellent service to members and providers

·Excellent oral and written communication skills; must be able to communicate clearly with members, staff and external partners

·Must be able to work well under pressure, prioritize work with tight schedules and target dates in a high volume environment required

·Detail oriented with demonstrated organizational skills; ability to multi-task and follow up