1199 Seiu National Benefit Fund
Location: New York,NY, USA
Date: 2024-12-13T08:21:56Z
Job Description:
Responsibilities
- Supervise the National Benefit Fund (NBF) Hospital Claims front-end Processor/clerical unit staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
- Provide support to the unit's Manager and Assistant Manager in optimizing workflows, distribution and review of work; response to audits, and monitoring of claims production/inventory
- Ensure timely distribution and processing of claims through the Document Management System (DMS) and QNXT Pend Workflow, and of QNXT Call Tracking; resolve DMS-QNXT discrepancies
- Ensure claims/correspondence are finalized in accordance with member benefit and eligibility parameters; Summary Plan Description provisions; Coordination of Benefits (COB) guidelines; regulatory and pre-authorization requirements; Claim Check and Medicare National Correct Coding Initiative (NCCI) rules; provider/repricing network contract terms and timeframes; and Fund/departmental policies
- Monitor daily QNXT reports, work queue distribution/completion in the Document Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems
- Review and assess staff member's performance with regard to quality/ productivity standards, audit results, and Health Insurance Portability and Accountability Act (HIPAA)/Compliance rules; provide audit rebuttal responses; meet regularly with staff to provide feedback/coaching; develop plans for additional training to remedy shortcomings; take correction action when necessary, to ensure the staff meet departmental/Fund requirements
- Process high dollar claims at the Supervisor level; serve as back-up to Manager/Assistant Manager in their absence to ensure operational activities are achieved and projects are completed
- Monitor timely workflow turnaround of documentation between the clerical staff and the Eligibility/COB and Provider Relations/Balance Billing Departments, to support claims finalization
- Prepare weekly and monthly reports on unit inventory, activities, production, and progress
- Prepare and maintain attendance/ lateness records and weekly timesheets for payroll to ensure compliance with Funds' policy and procedures
- Coordinate testing of QNXT claims processing system in preparation of system enhancements/contract changes, and report/track issues
- Perform special projects and assignment as assigned by management
Qualifications
- Bachelor's Degree in Health Administration or equivalent years of work experience
- Minimum of three (3) years' hospital claims processing or health claims Quality Control Reviewer/Auditor experience required; to include one (1) year leadership role required
- Basic knowledge of basic Microsoft Word and Excel preferred
- Strong knowledge of CPT, ICD-10, HCPCS, UB-04, hospital reimbursement methodologies and contracts
- Knowledge of eligibility, medical terminology, third-party reimbursement; COB; basic Microsoft Word/Excel
- Strong analytical, critical thinking, interpersonal and communication skills (written and oral)
- Good leadership skills and ability to direct and motivate staff
- Excellent organizational skills; able to multi-task, work well under pressure, prioritize and follow-up