Chief Clerk III

Job description

Qualifications: - Maintain accurate data entry of 199SEIU member information in hospital claims processing system (QNXT) - Track and ensure completeness of daily inquires; ensure they are sent to appropriate payment area for adjustment including but not limited to DMS (Data Management System) - Prepare MSP (Medicare Secondary Payer) claims/rebuttals, scan and archive supporting documents - Scan and archive documents into DMS (Data Management System) - Mail and maintain reconsideration letters including maintaining of acknowledgement of reconsideration letters - Track misdirected provider inquiries received from internal departments within the Fund, enter memo into QNXT and upload document to DMS (Data Management System) - Handle claim pending with edits for preparation of external transmission files, including review of aged edit(s), retrieval, and assignment of determination of incoming transmission files, follow up, sort and data entry of transmission files related information as needed - Review and maintain daily utilization management of claims and/or documents to ensure information is accurate and loaded in the claims system are correct, including updating memos and internal t...