Medical Claims Administrator

Description

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone.

Our Claims Team is primarily responsible for ensuring timely and accurate payments of member claims. The position requires excellent phone and email skills with the ability to adapt correspondence to a wide variety of audiences, including attorneys, claims adjusters, claimants, physicians, and structured settlement brokers.  The role works closely with the client engagement team, member care team, and management team to keep our members happy and compliant with their settlements.

PRIMARY RESPONSIBILITIES:

• Assess if billed services are related to a member’s accident or injury.

• Assess if billed services are compliant within the guidelines of the member’s settlement.

• Review settlement documentation to evaluate prior authorization requests.

• Manage the bill payment process including detailed review and analysis of claims to ensure proper treatment of funds.

• Maintain expected turnaround times in assigned claims statuses.

• Identify claim issues, and work towards a fast resolution.

• Handle incoming & outgoing claim calls, emails, and chats while maintaining a pleasant and helpful demeanor.

• Record, track and follow up on all correspondence while maintaining member confidentiality.

• Coordinate with providers to proactively resolve billing errors and/or discrepancies.

• Act as a resource for member care and pharmacy agents in need of billing assistance.

• Assist in identifying enhancements within existing processes.

• Lead or participate in special projects as assigned by Management.

• Demonstrates a commitment to service by consistent attendance and punctuality.

REQUIRED SKILLS/EXPERIENCE:

• Well versed with healthcare and medical terminology

• 2-4 years of experience with ICD-10, CPT, NDC and HCPCS coding and procedures

• Understanding of Medicare coverage guidelines

• Meticulous attention to detail

• Highly organized and focused with the ability to prioritize and multitask

• Aptitude for problem-solving

• Sound business judgment and computer skills

• Excellent written and verbal communication skills with ability to adapt communication style depending on audience

• Ability to work independently and as part of a team

• A desire to continue to learn and improve both self and the organization

The estimated salary range for this position is $24.00 to $27.00/hr. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation.

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In addition to our benefits package, employees have the opportunity to get involved with engagement, diversity, and philanthropic initiatives from their first day working with us to help us achieve our goal of Limitless Inclusion for All. As Ametros Citizens, we work together to foster an environment of limitless inclusion and belonging that encourages, supports, and celebrates the diverse voices and backgrounds of our people, while energizing the passion and innovations to revolutionize our industry.

Ametros is an Equal Opportunity Employer