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Par Reconsideration Coordinator

Req #: 107210
Job Location(s): Brooklyn, NY
Zip Code: 11220
Category: Office and Administrative Support
Agency: Elderplan
Status: Regular Full-Time
Office: Office-based

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No? You will here! You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals. You take care of our patients, residents and health plan members, and we will take care of the rest!

Benefits include:

  • Sign-on Bonuses OR Student Loan Assistance for clinical staff
  • FREE Online RN to BSN and MSN degree programs!
  • Tuition Reimbursement for all full and part-time staff
  • Dependent Tuition Reimbursement for clinical staff!
  • Generous paid time off
  • Affordable medical, dental and vision coverage for employee and family members
  • Two retirement plans! 403(b) AND Employer Paid Pension
  • Flexible spending
  • And MORE!

Responsibilities:

Process par reconsideration requests and non par reimbursement disputes in order to ensure requests are finalized within the established regulatory and contracted time frames. Investigation and analysis of par reconsideration requests to include: Reimbursement disputes, coding issues, benefit issues and medical necessity denials. Investigate claims issues received by Regulatory Compliance regarding Department of Insurance (DOI), Centers for Medicare & Medicaid (CMS), Attorney General (AG) and any other regulatory agency. Assists Supervisor with audits and monitoring of Par Reconsideration activity.

Qualifications:

  • Associates degree or 60 college credits.
  • Bachelor s degree preferred.
  • 2 4 years prior related experience is required.
  • Appeals and/or Grievance experience required.
  • Strong claims knowedge preferred.
  • Managed Care or Health Care related experience in a Medicare environment preferred.
  • Excellent organizational skills.
  • Very good communication skills (oral and written).
  • Good interpersonal Skills.
  • Detail oriented.
  • Ability to manage multiple tasks and work consistently in a fast-paced environment.
  • Working knowledge of claims processing and claims concepts.

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