Claims Technician/Senior Claims Processor - Hudson

University Hospitals Medical Practices (formally UPCP/UHMSO) was established in 1994. UH Medical Practices is the largest primary and specialty care physician group in northeastern Ohio, with a physician complement of over 340 physicians, covering an eight county area from Conneaut to Sandusky to Medina. The medical practice group consists of allergy, cardiology, endocrinology, family medicine, gastroenterology, general surgery, geriatrics, pediatrics, internal medicine, neurology, obstetrics/gynecology, ophthalmology, orthopaedics, otolaryngology, pediatric ophthalmology, pediatrics, physical medicine/pain management, podiatry, pulmonary medicine, rheumatology and urgent care.
Job Summary
The Claims Technician (Accumulators) is responsible for monitoring internal and external accumulator activities to ensure accurate exchange of accumulator import and export data, as well as identify when accumulator maximums have been exceeded and correct accordingly.
Key Responsibilities
Monitor electronic data exchanges between Health Design Plus and external vendors (e.g. prescription vendors) to ensure accurate data application into and out of the claims processing system.
Utilize accumulator related data reconciliation tools that include reporting, data files, and vendor websites.
Monitor on-going accumulator reports to ensure system accumulator accuracy. These reports include, but are not limited to, the following:
Import/Export error report
Weekly Reconciliation report
Monthly overage report
Correspond with external vendors (e.g. PBM's) as necessary to research and reconcile accumulator data.
Request reporting and perform analysis for focus accumulator reviews.
Assist with creating and updating accumulator procedures.
Assist in issue identification and problem resolution relating to all department escalated issues (e.g. Appeals, Claims, Customer Service, Provider Services, and Client Services).
Adjust claims to resolve deductible and out of pocket overages.
Test and document claim processing system updates and changes.
Additional Duties
Special project assignments
Other duties as assigned
Job Requirements (Education/Certification/Skills/Competencies/Experience)
Minimum of two (2) years experience in health claim processing/claim adjustment.
Experience in reading and interpreting health benefit plans.
Experience with accumulator reconciliation preferred.
Excellent analytical skills and ability to maintain high attention to detail.
Excellent verbal and written communication skills.
Proficient in the following computer skills: Excel, Word, Ultra Edit, and Access.
Equal Opportunity Employer - Minorities/Females/Protected Veterans/Disabled

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