Claims Data Entry Processor

The Company: AlohaCare is a local, non-profit health plan serving the Medicaid
and Medicare dual eligible population.
We provide comprehensive managed care to qualifying health plan members
through well-established partnerships with quality health care providers and community-governed
health centers. Our mission is to serve individuals and communities in the true
spirit of aloha by ensuring and advocating access to quality health care for
all. This is accomplished with emphasis on prevention and primary care through community
health centers that founded us and continue to guide us as well as with others
that share our commitment. As Hawaii’s third-largest health plan, AlohaCare
offers comprehensive prevention, primary and specialty care coverage in order
to successfully build a healthy Hawaii.
The Company: AlohaCare employees share a passion for helping Hawaii’s most
underserved communities. This passion
for helping and caring for others is internalized and applied to our employees
through a supportive and positive work environment, healthy work/life balance,
continuous communication and a generous benefits package. AlohaCare’s leadership empowers and engages its employees through
frequent diversity, recognition, community, and educational events and
programs. AlohaCare has a strong commitment to support Hawaii’s families and
reinforces a healthy work/home balance for its employees. Because AlohaCare
values honesty, respect and trust with both our internal and external
customers, we encourage open-door, two-way communication through daily
interactions, employee events and quarterly all-staff meetings. AlohaCare’s
comprehensive benefits package includes low cost medical, dental, drug and
vision insurance, PTO program, 401k employer contribution, referral bonus and
pretax transportation and parking program. These employee-focused efforts contribute to a friendly,
team-oriented culture which is positively reflected into the communities we
serve. The
Opportunity: The position is responsible for the front and back end support of
claims processing of the daily mail, scanning, validation of claims, checks,
provider remittance, and member explanation of benefit letters. This position requires the ability to
prioritize work to ensure the completion of the daily duties. Primary Duties and Responsibilities:
Opening
and sorting of the daily claims mail
Batching
and scanning of the daily claims
Daily
validation of incoming scanned claims
Filing,
logging and pulling claims as needed
Processes
the Member EOB’s for mailing
Ordering
of the claims department supplies
Responding
to requests from the State Medicaid office for information such as member
TPL requests
Logging
and distributing AlohaCare returned checks and provider refund checks
Direct
data entry into the claims systems of all claims and invoices that are not
scanned
Tracking
and logging claims that are not scanned
Filing
claims in an orderly manner for search and retrieval purposes
Responsible
for files sent off-site for storage
Identify
billing or processing issues and communicate to the supervisor or manager
Other
Duties as assigned
Perform
batch reconciliation of imported paper claims
·
Responsible to
maintain AlohaCare’s confidential information in accordance with AlohaCare
policies, and state and federal laws, rules and regulations regarding
confidentiality. Employees have access to AlohaCare data based on the
data classification assigned to this job title.Requirements:
Work
as a member of a team to complete common goals
Equivalent
combination of education, experience and credentialing.
Strong
verbal and written communication in English.
Requires
operation of general office equipment to include; PC, fax/copy machine and
ACD Mitel Phones.
Intermediate
skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
Type
40 words a minute and 10 Key by touch
Must
have the ability to read, analyze, and interpret business documents such
as Claims workflows.
Preferred Requirements ·
Previous experience with QNXT ·
Previous experience in mail handling or
mailroom experience·
Previous experience with scanning equipment Mental, Physical and Environmental
Demands: ·
Sedentary Work:
Exerting up to 20 pounds of force occasionally and/or a negligible amount of
force frequently or constantly to lift, carry, push, pull, or otherwise move
objects. Sedentary work involves sitting most of the time, but may involve
walking or standing for brief periods of time. ·
Inside working
conditions ·
No environmental
hazards ·
Requires operation
of general office equipment to include PC AlohaCare is committed to providing equal employment opportunity
to all applicants in accordance with sound practices and federal and state
laws. Our policy prohibits
discrimination and harassment because of race, color, religion, sex (including
gender identity or expression), pregnancy, age, national origin, ancestry,
marital status, arrest and court record, disability, genetic information,
sexual orientation, domestic or sexual violence victim status, credit history,
citizenship status, military/veterans status, or other characteristics
protected under applicable state and federal laws, regulations, and/or
executive orders.