We are currently seeking a candidate for a Medical Claims Expert who will perform membership enrollment and termination eligibility verification as well as ensure that accurate, complete and timely information in accordance with Government regulations and the guidelines of the Membership Administration Department are available for processing.
Understands and maintains working knowledge of internal eligibility requirements for all lines of business.
Review and verify all applications and/or correspondence to ensure eligibility accuracy.
Track and monitor direct pay COBRA member eligibility.
Research, verify and process documents for all lines of business assuring adherence and compliance within Company's policies and procedures.
Coordinate/communicate with various departments, members and employer groups verbally and/or within
Access to provide and/or obtain information. Review and respond to inquiries and correspondence to follow-up with appropriate actions.
Calculate and determine outstanding balances that are due for IF members.
Responsible for mailing denial and/or incomplete letters to prospective IF members.
Retrieve daily census from hospital to properly input newborn information and to properly distribute the
information according to set guidelines and procedures.
Identify and rectify any eligibility problems within Membership's scope (merges, dual enrollments, etc.) Determine, group and mail out student certifications and letters based on the group and the status of the member.
Review monthly report to determine who should be terminated or not and act accordingly.
Receive and insert student information in the system.
Determine and send the correct newborn letters based on the member and group.
Perform all other related duties as directed.