3 jobs found

Summary Description Encounters data is essential for monitoring and measuring managed care quality, finance, utilization and compliancy with state and contractual requirements. It is a critical source of information for rate setting, HEDIS score and risk adjustment. The Encounter team is responsible for receiving, capturing, validating, tracking submission, reconciling response files and error correcting rejections of encounters data rendered to members. The Encounters Analyst will be supporting the Claims and Encounters business unit as the expert to review internal and external rejections, identify the root cause of the rejection, provide detailed analysis of the root cause, provide recommendations and error correction of data. A strong understanding of the system and state regulation to collect and validate data required to improve submission of encounters reporting is highly recommended. Key Tasks and Responsibilities: Manage and monitor encounters submission, acceptance, rejection and response file inventory. Evaluate and conduct root cause analysis of internal and external errors. Manage and maintain requirement changes to ensure system validation rules and edits are up-to-date. Monitor and track inventory progress; remediate issues, produce progress reports and communicate to executive team. Support the capturing and updating of required data elements in various Itineris modules. Provide monthly summary report to executive team. Define solution approach to implement business objectives. Formulate business analysis plan to define specific list of deliverables, milestones and timelines. Elicit and discover necessary information to process and remediate errors based on state regulations.  Support technical implementation by reviewing solution designs to ensure requirements meet contractual and state mandates. Education & Training: Required: High School Diploma or GED. Preferred: Bachelor Degree in Business, Health Administration, Computer Science or equivalent work experience. Knowledge and Experience:  1-3 years of Itineris experience.  Strong knowledge of Itineris trips, contact, 834 and reservation modules.  Microsoft Excel, Word, FileMaker. Core Competencies:  Strong written and verbal communication.  Exceptional analytical skills.  Ability to communication and make recommendation for organization process improvement.  Strong problem-solving skills. Working Conditions : This is a Full time hourly position. Benefits after 60 days include medical, dental, vision, voluntary life and 401(k) No travel is required. Physical Requirements:     This position requires working on a sitting position working on a computer and operating a keyboard and a mouse as well as other office equipment like phones and printers, and filing documents.

Summary Description The People First Generalist (HR Generalist) at Secure is responsible for a multi-state operation. The Generalist must embrace our core values and culture and be effective in communication, people relations, policies & procedures, state & federal labor laws, and influencing desire results. The PF Generalist will report to the Vice President of People First and will work with other members of the PF team to ensure people and business initiatives are implemented consistently across our organization. The PF Generalist will be assigned internal client groups with the expectation to manage all aspects of human resources activities. Key Tasks and Responsibilities • Ensure you uphold and demonstrate the company core values at all times. • Present yourself in a professional, organized manner that conveys confidence. • Oversee the hiring process including recruitment of qualified staff. • Onboard new hires and consultants with engaging new hire orientations. • Overseeing the performance management process. • Providing support and consultation to supervisors on employee relations issues. • Ensure HR compliance regarding state and federal labor laws, reporting and investigations. • Administer and enforce company policies. • Manage benefits and leave administration activities. • Assist with employee engagement events. • Proactively Identify the needs for employee learning and development. • Other duties as assigned Education & Training • Knowledge of working in a multi-state company. Call Center experience a plus. • Payroll knowledge as it relates to recordkeeping and timesheets, a plus. • BA/BS degree preferred. Knowledge and Experience • Minimum of 3 to 5 years of generalist experience. • The ability to lead by example and be self-motivated and work with minimal supervision. • Strong mindset for continuous improvement and meeting or exceeding expectations. • Must demonstrate a high degree of confidentiality and professionalism. • Proficient in oral and written communication skills. • Computer literate with MS Office. • Willingness and ability to learn new software systems. • Knowledge of Federal and State labor laws. Core Competencies Possess effective communication skills, planning and organizing ability, be able to analyze complex issues and provide recommendations, ability to research and be resourceful, adaptable to change, high level of stress tolerance, demonstrate initiative, possess strong negotiation skills including persuasiveness, extreme attention to detail including accuracy regarding work. Working Conditions • Travel up to 25% may be required. Physical Requirements • Sitting for prolonged periods of time. • Lifting up to 10 lbs. may be required. Secure Transportation is an Equal Opportunity Employer

Summary Description Encounters data is essential for monitoring and measuring managed care quality, finance, utilization and compliancy with state and contractual requirements. It is a critical source of information for rate setting, HEDIS score and risk adjustment. The Encounter team is responsible for receiving, capturing, validating, tracking submission, reconciling response files and error correcting rejections of encounters data rendered to members. The Claims Processor will be supporting with reviewing, logging, batching, creating and issuing Claims Acknowledgement letters and Return to Provider letters, processing of claims, along with handling providers inquiry to claims payment. Key Tasks and Responsibilities • Review for accuracy and completeness of inbound claims. • Verify member eligibility. • Validate calculation of the reimbursable amount. • Create an Excel spreadsheet with necessary data items that serves as upload for payment from Finance. • Update Itineris with necessary member, rates and provider data. • Approve claims that are complete, eligible and accurate data elements. • Reject claims that are incomplete, inconsistent data elements or duplicates. • Print and mail Claims Acknowledgement letter to providers. • Print and mail return letter to providers with rejection reason. • Manage and respond to provider inquiries regarding claims status and payment by researching system for claims history. • Identify issues, report to Director and propose solution. Education & Training • Required: High School Diploma or GED • Preferred: Medical claims processing and billing Knowledge and Experience • Knowledge of CMS 1500 forms and fields. • Knowledge of required transportation HCPCS codes, modifiers, provider Medicaid ID, TIN and NPI. • Knowledge of state Medicare and Medicaid program guidelines and requirements. • Strong understand of Itineris and Excel software. • Strong data entry skills. • Excellent customer Service. Core Competencies • Strong organizational skills • Ability to communicate efficiently with multiple areas of the organization • Strong written and verbal communication skills • Track claims, payment and rejections • Ability to multi-task with frequent interruptions • Exceptional attention to detail and accuracy • identify missing or invalid claims data • Abide to deadlines Working Conditions • This is a Full time hourly position. • Benefits after 60 days include medical, dental, vision, voluntary life and 401(k). • No travel is required. Physical Requirements  • This position requires working on a sitting position working on a computer and operating a keyboard and a mouse as well as other office equipment like phones and printers and filing documents.