What are the responsibilities and job description for the Insurance Staff Support Specialist position at Forest County Potawatomi Community?
Here’s What You’ll Be Doing
- Re-price Contract Health Services/Purchased Referred Care eligible claims to the MLR /PRC for hospital and physicians for both internal and external clients; re-price employee health claims in their designated PPO software portals; assists in the production and distribution of benefit information to members employees and clients
- Maintains database of facility CMS Rate Notifications letters and submits to data vendor as needed to ensure accurate re-pricing; updates and maintains Section 506 Recovery reimbursement data via excel spreadsheets
- Prepares and compiles documents for stop-loss and Catastrophic Health Emergency Fund reimbursements; updates and inputs pre-certifications and authorizations into claim adjudication
- Identifies documents for destruction, maintains destruction schedule and verifies documents are destroyed on site by document destruction vendor; prints and distributes daily reports and all letters generated by claims examiners
- Answers incoming customer service calls, manages departmental mail posting, sorting and distribution; assists walk-in customers promptly and courteously
- Assists Accounting Specialist with in-house check runs and creates departmental purchasing requisitions for the Director’s approval; types letters, reports, memos and create flyers as requested by supervisor
- High school diploma or GED
- Two (2) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
- Must obtain and maintain HIPAA and Insurance Marketplace CAC certification
- Knowledge of medical terminology and health/medical insurance
- Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint
- Ability to communicate effectively and represent organization in a professional manner
- Must successfully pass all applicable background checks and drug screens
- Four (4) years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
- Experience with Indian Health Service preferred
- Approximately 5 weeks of paid time off annually
- 3 weeks of paid holidays
- Premium free health insurance
- Flexible spending accounts
- Short term disability
- Life insurance
- 401k with match