Claims Clerk IV

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview

This position is responsible for performing various tasks within the Claims department. Under supervision, this individual will be responsibility for daily clerical activities associated with the receipt and distribution of incoming mail, and Claim receipts. In addition, this individual will address inquiries received through standard mail, through internal referrals or electronically submitted via external MetroPlusHealth vendors. This individual is also responsible for performing accurate data entry and maintaining data records and files.

9:00 A.M – 5:00 P.M 

Mail Intake

Hard Copy Mail

• Responsible for the daily receipt of all incoming department mail, referrals and inquiries.
• Responsible for date stamping, sorting and recording of all department mail, referrals and inquiries.
• When required, forwards mail to external vendor for scanning/OCR process.
• When required, date stamps, and create batch sheets and files according to receipt date.
• Gives all completed batches to be internally scanned.

Electronically Scanned and Submitted Mail

• Responsible for the confirmation and/or data entry of submitted data into MetroPlusHealth’ work distribution system.
• Responsible for utilizing Claim database to verify or search for data when required.
• Utilizes Claim database to identify applicable service types and lines of business
• Utilizes the work distribution system to route mail to appropriate departments and Claim units.• Email electronically submitted documents when required to internal staff and departments.

Outgoing Mail

• Print all auto generated letters from Claims database (Powerstepp).
• Print out all provider response letters created by correspondents and submitted to clerical.
• When required, create response letter(s) from applicable template.
• Folding, envelope stuffing, and delivery of outgoing correspondence to the mail room.

Faxes

• Receipt, screening and distribution of incoming faxes.
• Faxing info requests, acknowledgements and responses to providers where applicable.

Additional Tasks

• Scans all auto generated and manually created letters into MACESS application.
• Scans all additional documents presented to clericals involved in inquiry resolution process.
• Maintenance of spreadsheets when required.
• Other duties as directed by management.

• High School Diploma/GED required.
• Six (6) months of full-time satisfactory clerical experience in a medical setting or in an administrative support role.
• Keyboard familiarity with the ability to type at a minimum of 100 keystrokes (20 words) per minute.
• Knowledge of medical terminology.
• Knowledge of HIPPA guidelines regarding Protected Health Information.
• Handling of/or familiarity with medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.
• Proficiency in Microsoft Word and Excel.
• Must be able to work in a fast-paced environment.

Professional Competencies

• Integrity and Trust
• Customer Service Experiences
• Functional/Technical skills
• Written/Oral Communication

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• Loan Forgiveness Programs for eligible employees
• College tuition discounts and professional development opportunities
• College Savings Program 
• Union Benefits for eligible titles 
• Multiple employee discounts programs
• Commuter Benefits Programs

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