Allegiance Benefit Plan Management, Inc
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Stop Loss Reimbursement Specialist
at Allegiance Benefit Plan Management, Inc
- 01-Oct-2020 to Until Filled (MST)
- Florence, MT, USA
- Full Time
REPORTS TO: Stop Loss Supervisor LOCATION: Missoula FLSA STATUS: Non-Exempt
The Stop Loss Reimbursement Specialist (SLRS) is responsible for supporting the coordination and filing of Specs, Advance Funding, Aggregates and Renewals. Having a firm knowledge and understanding of the claims processing software is necessary to perform informational research. The SLRS must compile on a monthly basis the aggregates in Excel to circulate to clients.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
1. Daily coordination of Specs, email correspondence, AL&H Period Set-up and discount negotiation
2. Coordinate Advance Funding. Including but not limited to review and cross-reference of the spreadsheet and reporting to accounting. Post payments
3. Collaborate with StarPoint to run risk lists, inpatient Reports, in-patient high dollar claims and MCA. This includes performing phone calls updating spreadsheets and running reports out of Acuity.
4. Maintain monthly ABPM period set-up, tracking of discharges, updating of claims renewal spreadsheet and report Spec balanace to MCA.
5. Organize renewals including making phone calls, running reports, reviewing pre-certs and coordinating collections.
6. Oversees the preparation of monthly aggregate reports, analyzes data, and files requests for aggregate reimbursement when necessary.
7. Maintains a database of all information pertaining to specific and aggregate requests and receipts of reimbursement.
8. Monitors all reinsurance requests to ensure receipt of reimbursement.
9. Responds to audit requests by gathering (or directing appropriate parties) to gather the requested information for pre-audit work; reviews all information being sent out for accuracy and appropriateness.
10. Gathers information for submission to underwriters for renewals. This includes coordinating with case managers and compiling all necessary information regarding lasers and large / potentially large claims.
11. As assigned there will be a need to conduct LuminX testing, pull EOBs/Claims for Audits, 50% backup and maintenance with IT and coordinate PPO/Rxd Backup.
12. Contributes to the daily workflow with regular and punctual attendance.
NON-ESSENTIAL JOB FUNCTIONS:
1. Performs related or other assigned duties as required or directed.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting: 75% Reaching: Some
Standing: 15% Manual Dexterity: Medium
Walking: 10% Telephone: Yes
Kneeling: Some Computer Screen: High (visual acuity corrected to 20/30)
Bending: Some Lifting up to 40 lbs.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education: High school graduation or equivalence required.
Certification(s) Required: Completion of required training programs through HIAA, ICA and/or LOMA, and continuing education courses or seminars relative to reinsurance and related topics.
Minimum Experience: Basic computer experience and extensive knowledge of the company's claims process and claims software required. Advanced knowledge of Excel preferred.
Excellent oral and written communication skills required.
Ability to prioritize problems and responsibilities.
Extensive PC skills, including Windows, Excel and Word.
Considerable knowledge and understanding of the claims processing software as is necessary for informational research.
Minimum typing speed of 50 wpm.
Strong mathematical skills.
Extensive knowledge of medical terminology, procedures and health insurance concepts.
Ability to understand plan document language accurately as it applies to benefits and apply rules, regulations and plan provisions to specific situations.
High level of interpersonal skills to work effectively with others.
Ability to organize and recall extensive volumes of detailed, complicated information.
Ability to project a professional image and positive attitude in any work environment.
Ability to comply with privacy and confidentiality standards.
Ability to manage time and job duties without daily supervision.
Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
Ability to operate typical office equipment.
Working knowledge of general office procedures.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.
*Allegiance Benefit Plan Management, Inc is an Equal Opportunity Employer.