<p>SEIU Local 105 - $28.35 - $38.62</p> <p>"May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.</p> <p>Job Summary:</p> <p>Through comprehensive assessment and analysis, adjudicates managed healthcare claims/bills, authorizations and referrals, for payment or denial within contract agreement and/or regulatory requirements. Performs these duties using industry standard knowledge of managed healthcare claim/bill payment processing and medical regulations, verifies and updates relevant data into various computerized internal and external systems.</p> <p>Essential Responsibilities:</p> <ul> <li>For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills. </li><li>Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed. </li><li>Proactively communicate with internal departments as appropriate to resolve claims issues promptly. </li><li>Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes. </li><li>Proactively communicate with internal departments as appropriate to resolve claims issues promptly. </li><li>Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits. </li><li>Communicate problems and/or trends to leads and management. Understand and apply county, state and federal regulations. </li><li>Other duties as assigned within department job functions. </li></ul>