Company Overview:
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Job Summary and Responsibilities:

JOB SUMMARY:

This position is responsible for supporting the Utilization Management process by adhering to
internal policies and procedures and utilizing working knowledge of the organization’s services to
meet productivity and quality standards. The Claims Services Coordinator will work with the
clinical team to perform daily reporting functions necessary for the timely completion of UM
cases.

REQUIRED QUALIFICATIONS

• High School Diploma or GED
• 2+ year’s clerical or data-entry work OR 2+ year’s customer service experience in a healthcare or similar environment or industry.
• Proficiency in Microsoft Office suite including the use of Outlook, Word, and Excel applications.
• Effective verbal and listening skills to provide courteous and professional customer service.
• Effective PC skills including electronic mail, intranet and industry standard applications.
• This position may require coming onsite to our Tysons’ Corporate Office 1 day per week to assist with Mail Duties

PREFERRED QUALIFICATIONS

• Experience with medical billing
• Knowledge of Medical terminology
• Experience with the Health insurance industry
• Medical terminology course(s)
• Ability to work in a fast-paced environment
• Ability to multitask to complete daily required tasks, often in different programs.

• Act as the main client contact for all claims systems inquiries, reporting, and issues.
• Prepare a daily report of the expiring claims and report to the Program Director if these identified claims cannot be completed timely.
• Coordinate with staff in the Tyson’s office to ensure Corrections mail, medical records, and reports are received and retained.
• Report and track all quality concerns (i.e. Incorrect billing) to the client and Program Director.
• Serve as team coach/ mentor to peers on the Claims team
• Develops and maintains working knowledge of internal policies, procedures, and services(both departmental and operational).
• Utilizes automated systems to log and retrieve information. Performs accurate and timely dataentry of electronic faxes.
• Receives inquiries from providers by telephone, email, fax, or mail and communicatesresponse within required turnaround times.
• Responds to telephone inquiries in a prompt, accurate, and courteous manner followingstandard operating procedures.
• Interacts with hospitals, physicians, beneficiaries, or other program recipients.
• Performs verification of healthcare services to facilitate payment for received services.
• Identifies medical claims meeting CPT/DRG audit criteria and submits the necessary billingdata and healthcare records to the third-party auditor.
• Serves as liaison between the client, medical billing coder/ auditor, and external providers.
• Investigates and resolves or reports provider problems. Identifies and escalates difficultsituations to the appropriate party.
• Meets or exceeds standards for call volume and service level per department guidelines.
• Initiates cases by collecting and entering demographic, provider, and procedure informationinto the system.
• Serves as liaison between the Corrections clinical team and external providers.
• Responsible for the completion of daily, monthly, and quarterly reports necessary for theclinical team operations and client reporting.
• Act as the main client contact for all claims systems inquiries, reporting, and issues.
• Prepare a daily report of the expiring claims and report to the Program Director if these identified claims cannot be completed timely.
• Coordinate with staff in the Tyson’s office to ensure Corrections mail, medical records, and reports are received and retained.
• Report and track all quality concerns (i.e. Incorrect billing) to the client and Program Director.
• Serve as team coach/ mentor to peers on the Claims team
• Read, understand, and adhere to all corporate policies including policies related to HIPAAand its Privacy and Security Rules
  The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.
  Qualifications: