Essence Healthcare is a physician led Medicare Advantage Health Plan currently operating in service areas in Missouri, Illinois, Kentucky, Indiana, New York and Washington, with plans for future expansion. The intimate relationship between physician and nurses with the health plan allows Essence to integrate information systems to inform the clinical care and help all focus on managing individuals as well as populations of patients with disease. 

Since enrolling its first member in July of 2004, it has grown to over 30,000 members and continues to grow and expand both at its St. Louis Headquarters and into new markets.

Summary: 

This position identifies via audits training needs and written documentation to support the Claims/Customer Service Representatives by addressing their needs and allow them quick and accurate access to information to help reduce call talk time and ensure accuracy of the information.  This position creates and maintains all dept documents and reference guide material.  This position should seek out training opportunities on an ongoing basis along with developing quick reference guide types of material, develops and maintains a detailed training plan.  This position audits all functions including claims data provided by the delegated entities and takes appropriate action or reports to the appropriate parties.   

This position will work closely with all positions in the department & must be willing to travel to current or future markets as necessary. 

Qualifications Needed:

Ability to track and trend issues

Excellent oral and written communication skills

Ability to take complex information and create easy to follow training materials

Develop problem resolution as issues surface

PC knowledge especially Microsoft Word & Excel

Knowledge of Federal & State Healthcare regulations, Essence benefits and how they are administered, P & P’s, Contracts etc.

Specific Responsibilities:

Audits claims & phone calls by the Claims/Customer Service representatives

Audits adjustments, correspondence, documentation etc. along with any new tasks that might be created

Audits all delegated entity claim files for accuracy and timeliness

Identifies ongoing training needs & creates material to address those needs

Identifies system set-up problems and inconsistencies in contract reimbursement issues

Creating documentation to promote consistency throughout the department

Makes workflow & process improvements as necessary

Assists others with difficult/complex claims resolution issues

Works dept disallow report

Responsible for all new hire & refresher training for all markets

We offer competitive salary and excellent benefits, Including 401k, EOE

Please Apply at

http://jobs-essencehealthcare.icims.com /