Documents Processor II - Claims (Hybrid with On site in Troy, MI) - Health Alliance Plan
General Summary:
To ensure all incoming claims/documents are distributed and routed accurately to the appropriate departments. Utilizing Pega and Facet systems to increase the efficiency of the Claim and Enrollment departments by providing support for the Claims Processors, Enrollment Reps., Adjustment Reps., and COB Analysts. Coordinate and participate in departmental activities to increase efficiency and process layout.
Principal Duties and Responsibilities:
- Open, sort, batch, and distribute incoming mail daily.
- Utilize the scanner to record claim, cob and enrollment documentation according to appropriate inventory type.
- Validate and release the recorded scanned documents into the appropriate database system.
- Process unaccepted reports, Data Direction Incorporated-(DDI) returned mail, sorting and mailing of Explanation of Benefits (EOBs).
- Mail request to provider for additional claim information when pertinent information is missing.
- Maintain accurate files of claims, claims reports and all related documents.
- Navigate through the CRM Pega system to create/close COB, and Claims processing pega cases for the appropriate COB Analyst and Claim Processor to analyze and resolve each case created.
- Navigate through the Facet system to retrieve member or claims missing information.
- Navigate through the Facet system to verify if a claim was previously submitted.
- Navigate through the Facet system to input claim adjustment and appeals information for the appropriate Adjustment Processor to analyze and resolve.
- Record daily production and time including CTO time. Compile bi-weekly reports reflection lost time information.
- Provide back-up for other co-workers in the division.
- Perform other related duties as assigned.
Education/Experience Required:
- High School Diploma or equivalent.
- Basic computer skills including word and excel, e-mail, etc.
- One (1) year general clerical office experience required.
- Effective communication and interpersonal skills.
- High level of organizational planning and time management skills.
- Previous experience as a Documents Processor-Claims preferred.
- Background in records maintenance or records management preferred.
- Medical terminology, ICD-9 and CPT-4 preferred.
Physical Demands/Working Conditions:
- Typical office environment.
- Sedentary – Exerts up to 10 lbs. of force occasionally to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for periods of time.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.