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Claims System Liaison
2 months ago
We are seeking a highly skilled Claims System Liaison to join our team at Presbyterian Healthcare Services. As a Claims System Liaison, you will play a critical role in providing technical claims analysis, resolving complex claims problems, and serving as a liaison between claims areas and other functional areas within our organization.
Key Responsibilities- Claims Analysis and Resolution: Provide technical claims analysis and resolve complex claims problems in a timely and efficient manner.
- Liaison and Communication: Serve as a liaison between claims areas and other functional areas within our organization, ensuring effective communication and collaboration.
- Policy and Procedure Development: Analyze policies and procedures to determine changes needed and develop written changes to ensure compliance with regulatory requirements.
- Training and Support: Participate in testing of new system configuration to ensure accuracy of operations policies and procedures and training materials.
- Compliance and Regulatory: Assist with ensuring policies and procedures are in compliance with CMS, DOI, and NCQA and HEDIS requirements.
- Claims Processing and Adjustments: Perform claims adjustments and claims processing as necessary and other functions as required.
- Education: High School Diploma required and two to three years college level courses/Associates Degree/Diploma or Bachelors Degree in business administration or related field preferred.
- Experience: At least 3 years experience in health insurance claims processing and/or related operational areas within a health insurance managed care environment demonstrating a strong knowledge of claims processing.
As a Presbyterian Healthcare Services employee, you will receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Our Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
About Presbyterian Healthcare ServicesPresbyterian Healthcare Services exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
