Claims Clerk

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth's has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

This position is responsible for performing various tasks within the Claims Department. Responsibilities include but are not limited to the daily activities associated with the receipt and distribution of incoming mail, claim receipts and inquiries received via standard mail, through internal referrals or electronically submitted via External MetroPlusHealth Vendors. Incumbent is responsible for performing accurate data input where applicable and maintaining accurate records and files.

Mail Intake
Hard Copy Mail

• Incumbent is responsible for the daily receipt of all incoming department mail, referrals, and inquiries.
• Incumbent is responsible for date stamping, sorting, and recording of all department mail, referrals, and inquiries.
• When required, forwards mail to external vendor for Scanning/OCR Process
• When required, Date Stamps, Creates a batch sheet and files according to receipt date.
• Gives all completed batches to be internally scanned.

Electronically Scanned and Submitted Mail

• Incumbent is responsible for the confirmation and/or data entry of submitted data into MetroPlusHealth's Work Distribution system.
• Incumbent is responsible for utilizing Claim Database to verify or search for data when required.
• Utilizes Claim Database to identify applicable Service Types and Lines of Business
• Utilizes Work Distribution system to route mail to appropriate Departments and Claim Units
• Email Electronically submitted documents when required to internal staff and departments

Outgoing Mail

• Prints all auto generated letters from Claims Database (Powerstepp).
• Prints out all Provider Response letters created by Correspondents and submitted to Clerical.
• When required, creates response letter(s) from applicable template.
• Folding, envelope stuffing, and delivery of outgoing Correspondence to the Mail Room.

Faxes

• Receipt, Screening and Distribution of incoming faxes
• Faxing Info requests, Acknowledgements and Responses to providers where applicable
• Prints out all Provider Response letters created by Correspondents and submitted to Clerical.

Additional Tasks

• Scans all Auto Generated and Manually created letters into MACESS Application
• Scans all additional documents presented to Clericals involved in Inquiry resolution process
• Maintenance of spreadsheets when required
• Other duties as directed by Management

• High School Diploma/GED
• 18 months of prior clerical experience
• Proficiency in Microsoft Word and Excel
• Customer Service Experience a plus.
• Must be able to work in a fast-paced environment.
• Excellent written/verbal communication skills.

Additional Qualification

• Processing of Medical Claim Forms (HCFA, UB04)
• Knowledge of Medical Terminology
• Knowledge of HIPPA Guidelines regarding Protected Health Information
• Data Entry of Provider Claim/Billing information
• Handling of/or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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