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Title

Claims Assistant 

Description

Peak Health Plan Management Services offers PACE third party back-office solutions, including claims processing, billing and health plan management solutions, along with over a decade of serving PACE/LIFE programs throughout the United States. Peak Health Plan Management Services operates as a service of Capstone Performance Systems, a subsidiary of Tabula Rasa HealthCare.

Under the supervision of the Claims Manager, the Claims Assistant is responsible for supporting processes for the claims department. Key responsibilities include keying provider invoices, repricing outpatient hospital claims, auditing pre-check registers, and mailing checks, EOBs and various letters to providers.

Essential Functions:

Clerical

  • Key various types of invoices into claims system
  • Reprice inpatient and outpatient hospital claims
  • Mail reject and denial letters to providers
  • Review weekly pre-check registers
  • Prepare provider checks and EOBs for mailing
  • Assists with phone coverage
  • Special projects as assigned

Additional Functions:

  • Communicates clearly and concisely, with sensitivity to the needs of others

  • Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards; will support the success of the entire team; establishes and maintains effective working relationships with co-workers

  • Follows all Policies and Procedures and HIPAA regulations

  • Maintains a safe working environment

  • Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees

  • Establishes and maintains effective working relationships with co-workers

Supervisory Responsibility: None

Travel: Minimal travel, less than 10% is expected for this position.

 
Position Requirements
  • Education/Experience – Educational requirements include a high school diploma or equivalent. Minimum of one year of previous office experience required.
  • Requires strong knowledge of current computer technology, including the use of computers; Intermediate level of knowledge and proficiency with associated software, including Word, Excel and Outlook. Experience with mail merge is preferred. Working knowledge of health insurance is helpful.
  • Skilled in establishing and maintaining effective working relationships with co-workers and clients
  • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
  • Detail oriented with strong analytical skills
  • Ability to work independently, seeking supervision as needed
  • Ability to communicate professionally, clearly and effectively, verbally and in writing
  • Ability to effectively fulfill all functions of the position

Physical Demands & Requirements:

  • Communicates by way of the telephone with participants, customers, vendors and staff
  • Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
  • Remains stationary for extended periods of time
  • Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects
  • Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
  • Occasional reaching to retrieve shelved items

Work Environment:

  • This job operates in a professional office environment with a conversational noise level.
  • No substantial exposure to adverse environmental conditions is expected
  • Moderate pressure to meet scheduled appointments and deadlines
 
Full-Time/Part-Time Full-Time  
Shift Days  
Position Claims Assistant  
Post Internal Days 0  
Number of Openings 2  
Location Peak Pace Solutions- St Louis  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 


This position is currently not accepting applications.

To search for an open position, please go to http://TabulaRasaHealthcareInc.appone.com



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