Health Care Payment Specialist

Job description

Salary Pay Range: $27.05/hr.-$34.95/hr. Essential Functions: - Communicates with other employees/customers through written, oral and face-to-face interactions. - Participates in discussions about confidential/sensitive matters, maintains confidentiality of patients at all times. - Coordinates benefits with providers through means of patient referrals, discussing individual cases to ensure continuity and follow up of care. - Provides assistance with Medicaid application process and refers patients to alternate resources. - Coordinates benefits and assists tribal members with alternate resources available. - Loads, verifies accuracy and processes all claims for Tribal member health program, manually and via an imported file from the Third-Party Administrator (TPA). - Coordinates & Communicates claims issues with TPA ensuring proper use of all network discounts and alternate resources available. - Determines level of patient care to ensure services are within payment guidelines. - Ensures the integrity of data entered for PRC and tribal member health program check processing; pre-report, document control register, vendor payment, vendor claim report, object class code report, check ru...