Description: |
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Manley Services was founded in April 1987, and became part of the
PacificSource Health Plans group of companies in March 2003. We are
a licensed third party administrator that works with insurers,
employers, and associations to provide consulting assistance in
designing, implementing, and administering their benefit plans. We
currently provide these services for more than 2,000 organizations
around the country, though primarily in the Northwest. Our
management team has over 100 years combined experience in the
insurance industry, employee benefit plan administration, and
management services.
** THIS IS A TEMPORARY POSITION FROM APPROXIMATELY
11/15/09 THROUGH 4/15/10. **
Nature and Scope:
Assistant Claims Representative will accurately interpret regulatory
guidelines for claims processing. Review and research claims and
determine coverage based on plan documents and claims processing
guidelines. Adjudicate claims for payment or denial within Manley
Services standards for quality and production.
Essential Functions:
Accurately process claims by researching benefits and claims policy
and procedures. Research also includes, but is not limited to:
reading all related notes (general, claim, case, subscriber, etc.),
comparing procedures to diagnostic codes, determine plan year based
on service date, determine if documentation is a manual claim or
debit card swipe, watching for duplicate billings, watching for
inconsistencies between billed and election amount, and review all
other system connected information that may be pertinent
Read and understand group plans documents and benefits language.
Accurately interpret benefits and policy provisions and apply
appropriately to claims. Verify accurate data entry including
member information, plan year, coding, dollar amounts and if
required, denial code. Release claim for payment or denial when
research is complete, and claim is accurately adjudicated. Work in
assigned claims processing queues and assist in other areas as
needed.
Use “notes” systems to record pertinent information involving a
claim or a member. Document issues that affect other departments
and advise appropriate internal personnel of claims processing
concerns and/or problems. Use established communications channels to
notify internal departments and personnel. Must meet or exceed
department standards for accuracy and production. Understand the
importance of courtesy to internal and external customers. Follow
department and company-wide policies and procedures. Follow the
Manley Services privacy policy and HIPAA laws and regulations
concerning confidentiality and security of protected health
information. Perform other duties as requested.
Qualification Requirements:
Work Experience: Minimum of 1 to 3 years of previous work
experience with strong data entry and decision making skills
demonstrated. Claims adjudication experience and/or knowledge of
medical terminology and medical coding preferred.
Language skills: Ability to clearly communicate in person and over
the telephone and is able to request and exchange information in a
pleasant, respectful and professional manner.
Mathematical Skills: Requires basic math skills.
Reasoning Ability: Education, Certificates, Licenses, Registration:
Requires high school diploma or GED.
Other Skills and Abilities: Able to prioritize work and perform
under time pressures. Advanced PC skills, ability to type using a
standard keyboard and operate a 10-key pad accurately.
Additional Details:
Wages are $10.50 per hour, with no benefits offered. Manley Services
will be closed for the holidays, which allows our temporary workers
several days off to enjoy time with their family.
For more information on this or other positions and to complete a
required application, please visit us online at
http://www.manleyserv.com and click on About Us/Employment
Opportunities.
You may also submit your resume/ work experience by using the "Apply
For This Job" link provided below.
Thank you.
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