Claims Encounter Specialist, Latham, New York

Job is expired

Created 10/12/2018
Reference 104849790
Country United States
State New York
City Latham
Zip 12110

Location
NY: Latham (10 British American Boulevard)

Job Family
Claims


Job Brief

We are currently seeking a dynamic Claims Encounters Specialist to join a new Beacon team in Latham, NY or Woburn, MA!

Non-Exempt

About the Position:

We are currently seeking a dynamic Claims Encounters Specialist to join a new Beacon team in Latham, NY or Woburn, MA! The Encounters Specialist will be responsible for monitoring and analyzing encounters as part of a company wide centralized unit. The encounters analyst also provides back-up technical support to other processors.

About the Unit:

Beacon has recently implemented Edifecs Encounter Management (EM), a new software system that will utilize its proprietary logic and technology to generate encounters out of its core system. In this process, the software will flag claims with potential errors-determined by state "knowledge packs" -- and send these claims to error "queues" where they will be reviewed by specialized encounters analysts. These analysts will also review and work encounter exceptions that do not meet state requirements to ensure we exceed our clients expectations

Please note that while errors will largely be worked in Edifecs' robust User Interface, encounters analysts should also be comfortable going into core adjudication systems. Additionally, this position is part of a completely new operational unit; while all analysts will report to one manager, they will not be required to all sit in one centralized location.

Position Responsibilities:
  • Analyze behavioral health encounters that require research and resolution, as flagged by Beacon's encounters software
  • Monitor encounters for trends in error types
  • Support testing of all system modifications and migrations.
  • Advise the Manager of any policies and procedures needed to support the unit
  • Contribute to a team environment by maintaining excellent interpersonal skills and demonstrating flexibility with daily operations/function.
  • Communicate system issues to management.


Position Requirements:
  • Education: High School diploma or GED equivalent required. Bachelors Degree preferred.
  • Relevant Work Experience: 2-3 years of claims processing or encounters experience in a health care environment or a minimum of 1 year internal claims processing experience required
  • Knowledge, Skills, & Abilities:
    • Flexcare experience strongly preferred (internal applicants only)
    • Strong encounters experience
    • Knowledge of claims adjudication
    • Strong problem solving and analytical skills
    • Ability to recognize trends in encounters data and synthesize and present findings
    • Strong communication skills
    • Understanding of EDI and SQL preferred but not required.


To Apply:

Click below on " Apply for this Position" to create a profile and apply for the position.

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

#GD

#CB

PM16

AAP Reporting Location:

NY - Latham

ID (Req #):

55505

FTE Status:

Full Time

Schedule:

40 hours per week

PI104849790

Employer Beacon Health Options

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