Benefit & Risk Management Services, Inc.
Claims Refund Clerk
hace 15 días
Sacramento
Job Description Summary: The Claims Refund Clerk would support the Claims Department and work within the TPL/COB Team. Essential Duties and Responsibilities include the following. Other duties may be assigned. • Works on site with consistent and reliable attendance., • Provider Gateway Support: Will support the registration process of the Provider Gateway system currently in place and monitored/managed by the TPL/COB Team, to include: monitoring of the communications of the “pending registrations” for Providers attempting to complete their information and manage online queries for status by same. Tracking to completion of registration(s) and monthly statistics of relevant registrations., • Responsible for tracking /logging duties and procedures associated with incoming refunds and overpayments pertaining to claims, including: compares data on claim with internal policy and other company records to ascertain completeness and validity of claim, maintains high quality standards to avoid paying claim incorrectly, refers most questionable claims for investigation to Supervisor for review, handle incoming refunds and overpayment checks pertaining to claims, log and track all refund checks that are being researched. Maintain status on refund log spreadsheet. Research as needed. Working interdepartmentally is critical to completion of this process., • Performs other duties and responsibilities as assigned by Management. Knowledge, Skills, & Abilities: • Excellent written and verbal communication skills., • Strong analytical skills and problem-solving skills., • Must be dependable and maintain excellent attendance and punctuality, • Must be able to perform data entry operations accurately., • Strong computer skills, including Word, Excel, and Outlook., • Proficient in ICD-10, CPT, and HCPCS codes extremely helpful, not required., • Returned Check Log: Support / Maintain log of checks returned to BRMS for “bad address.” This log is viewed by Accounting – Customer Support and requires follow-up action when a corrected set of information is received. ACTION is required to investigate possible “new addresses” for revision. Working with Provider Specialist is key relationship in this task., • Strict attention to detail., • Critical thinking, • Passion to resolve issues – “things that don’t make sense” without rejecting., • Not afraid to question anything that seems off……, • Other duties as required & assigned by management Supervisory Responsibilities: This job has no supervisory responsibilities. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: High school or G.E.D. equivalent; and minimum of two years of increasingly responsible office administrative, specialized administrative support or secretarial experience and/or training; or equivalent combination of education and experience. Language Skills: Ability to read, speak, and write effectively in English. Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, memos, letters, and forms. Ability to write routine reports and correspondence. Ability to speak effectively before customers or employees of an organization. Ability to effectively address or resolve customer service issues within guidelines of the position Mathematical Skills: Ability to add and subtract figures. Ability to add and subtract, multiply and divide with 10's and 100's. Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Certificates, Licenses, Registrations: None. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Company DescriptionEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs. One of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefitsEstablished in 1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.\r\n\r\nOne of the first to introduce employee benefit administration technology solutions, our services are powered by our exclusive Virtual Benefits Administration System (Vbas) a proprietary database and administration system that allows employers to save time and money by automating management of the benefit supply chain and empowering employees to self-service their benefits