Claims Coordinator

• Act as point-of-contact for appeal/dispute adjudication programs.
• Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and submission of case documentation, as necessary.
• Monitor appeal/dispute status and communication received on client portals.
• Conduct initial eligibility reviews and recommend course of action to internal team and department management.
• Track and assign cases using commercial off-the-shelf and custom software applications.
• Review and provide case documentation to assigned billers/coders, nurses, IPRO physicians and clinicians internal teams and key stakeholders to facilitate clinical and coding reviews.
• Monitor and measure key performance indicators including, but not limited to, timeliness, adherence to quality and accuracy standards, and deadlines for contract deliverables.
• Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
• Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation.
• Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps).
• Prepare billing invoices at conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments
• Mentor and train new staff, at all levels, on process steps and case progression.
• Other activities as may be deemed necessary.

Skills & Qualifications

• Bachelors or advanced degree in healthcare, business, management, or digital studies.
• Knowledge and experience with collaborative project management software, electronic documents, and design.
• Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills including phone manner.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative while multi-tasking.
• Ability to meet deadlines in time sensitive environment.