Reinsurance Coordination Specialist

Position Purpose:

Under the direction of the Manager of Claims, the Reinsurance Coordination Specialist is responsible for the processing, auditing, testing and reporting of reinsurance activity for Hometown Health and its respective third party partners.

Nature and Scope:

The Reinsurance Coordination Specialist is responsible for:

• Run reports for respective groups and their specific reinsurance policy period.
• Provide direct and secure electronic correspondence with third party partners.
• Coordinate complex reinsurance claims with Hometown Health Claims department and third party partners.
• Coordinate appeal process on denied reinsurance claims.
• Clear reporting and communication to senior leadership.
• Coordinate audit functions for third party partners and accrediting agencies as required.
• Acts as a liaison to resolve billing disputes, obtain appropriate documentation and achieve resolution. Identifies and reports aberrations to management as appropriate.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications:  Requirements - Required and/or Preferred

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Two-year degree from an accredited college or university or equivalent experience in a healthcare related field is required.

Experience:

Three years experience in claims or medical billing, managed care systems, including HMO, PPO, Dental, TPA, Medicare products and which included processing of coordination of benefits and subrogation. Knowledge of CPT, ICD9, HCPCS, ASA, ADA and DRG coding, required.  Medical terminology. Ability to understand the technical aspects of managed care systems. Ability to interpret health plan benefits and coverage.  Ability to interpret provider contract provisions.   Knowledge of state and federal regulations.

License(s):

None.

Certification(s):

None.

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.