Sr. Reconciliation Representative

American Specialty Health, Inc. is looking for an experienced and proficient Reconciliation Representative.  This position reconciles resolves, and researches claims, including complex claims, for payment.

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Responsibilities

  • Reconciles, resolves, and researches ASO payments to ASH.
  • System reconciles ASO claims payment from Health Plan Payors.
  • Makes calls to Health Plans to check status of payment or underpayment. Make courtesy calls to Providers as needed
  • Makes calls and researches overpayment requests from health plan recovery services.
  • Documents follow-up in Reconciliation System or Communication Log.
  • Prepares letters of explanation to Health Plans and prepares spreadsheet documentation of payments/overpayments/underpayments.
  • Completes check requests for reimbursements of overpayments to Health Plans.
  • Maintains confidentiality of all claims documents, records, and claims related issues.
  • Promotes a spirit of cooperation and understanding among all personnel.
  • Recognizes unique and/or problem situations within area of assigned responsibility. Researches and makes recommendations to Supervisor.

Qualifications

  • High School diploma required.
  • 2 to 3 years with claims processing, computer, typing, 10 key and telephone skills preferred.
  • 1-2 years experience as a Reconciliation Representative preferred.
  • Knowledge of Microsoft Word and Excel helpful.

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Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.