Spanish-Speaking Medical Claims Coordinator

1 week ago

Glastonbury, Connecticut, United States Complete Staffing Solutions, Inc. Full time
Job Overview

Position: Spanish-Speaking Medical Claims Coordinator

**Fluency in Spanish is required**

Summary:

The Spanish-Speaking Medical Claims Coordinator plays a crucial role in a dynamic work environment, requiring exceptional interpersonal and communication abilities, meticulous attention to detail, and strong analytical capabilities. This position involves managing administrative responsibilities related to client health premiums and out-of-pocket medical expenses, while also engaging with clients to address inquiries regarding services and products, as well as resolving complaints.

Key Responsibilities:

  • Lead the customer service and claims team effectively.
  • Provide customer support and process medical claims for designated programs.
  • Review and adjust medical insurance claims in compliance with established policies and procedures.
  • Handle incoming calls and respond to client inquiries regarding payments made to medical providers.
  • Address inquiries from medical providers concerning payments made or owed to program clients.
  • Initiate outgoing calls to medical providers and insurance companies as necessary.
  • Possess the ability to interpret explanation of benefits, claim forms, and healthcare terminology.
  • Identify, investigate, and resolve claim-related issues, while requesting additional documentation when needed.
  • Encourage teamwork and ensure successful service delivery.
  • Meet contractual performance guarantees related to the timeliness and accuracy of payment processing.
  • Ensure compliance with various client communication standards, including phone, email, and mail.
  • Process medical payments on behalf of clients.
  • Assist in the client appeals process as needed.
  • Maintain and update financial batch records to support accounting processes.
  • Oversee workflow to ensure service levels are consistently met.
  • Approve outgoing mail in the letter queue when necessary.
  • Revise and update departmental policies and procedures.
  • Work with clients experiencing high medical utilization.
  • Suggest process enhancements for improved efficiency.
  • Recognize, document, and report escalated issues to management.
  • Review and deny pending W9 claims.
  • Serve as the primary resource for staff inquiries.
  • Perform additional duties as assigned.

Education and Experience:

  • Associate's degree or equivalent experience, or a minimum of 4 years in a related field.

Specialized Training:

  • Familiarity with medical insurance practices, including enrollment, payment terms for insurance premiums and out-of-pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort. Previous leadership experience is preferred.

Certificates and Licenses:

  • Medical coding or billing certification is strongly preferred.

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