Log In
Sign Up
Job Description
OverviewThe Registered Nurse provides nursing care to individuals and groups which require specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, spiritual/cultural, and nursing sciences. The Registered Nurse functions within the full scope of nursing practice as noted by the Board of Nursing of their designated state for which they are practicing in addition to compliance with any of the hospitals accrediting bodies.
Full-Time
Level: Mid
Travel: No
SuccessProfileWho is the ideal Promedica employee? We’re looking for people to join our team who are motivated by making an impact and doing meaningful work.
Responsible 10
Compassionate 9
Communicator 9
Adaptable 9
Multi-tasker 8
Additional success profiles:
Detail oriented, Flexible, Helpful, Patient, Responsible, Sincere, Understanding
Benefits
Professional Growth
Retirement & Savings Plan
Innovative Training Programs
Tuition AssistanceCareer Stability
Comprehensive Health Coverage
Job Requirements
ProMedica’s health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website. http://www.paramounthealthcare.com .
The Claims Project Coordinator will serve as a single point of contact for Provider claims issues/concerns received through Provider Inquiry and Provider Relations. This role will be responsible for performing routine/complex analysis on historical claims, identifying and documenting claim trends and issues for stakeholders. This position will also help formulate solutions to the claim trends and issues presented. This position is also expected to stay current on all ODM, CMS and AMA changes related to claims processing, including but not limited to CPT/HCPCS, Revenue Code, Bill Types and industry standard code edit sets.
Accountabilities:
1. Serve as point person for Provider AR inquiries to include trend monitoring, root cause analysis, problem resolution
2. Coordinate with Contracting, Provider Relations, Provider Inquiry, Claims and IT to advise on trends when root cause is identified in an effort to avoid repeat complaints
3. Stays up to date on all coding/regulatory changes and assists (as appropriate) on advisement of system programming and/or policy changes. Would include changes released from ODM, CMS and AMA.
4. Support Provider Relations, Contracting and Provider Inquiry staff by timely responding to claim questions/concerns and help facilitate timely response from other internal departments as needed during the claims/appeals reconciliation process.
5. Serve as a back-up resource to the Provider Experience Communication Specialist and Provider Experience Support Specialist rolls
6. The Claims Project Coordinator (Provider Experience) will be expected to attend and participate in multiple meetings with providers and stakeholders, including monthly provider joint operations calls.
7. Other duties as assigned.
Required Qualifications:
Education : Bachelors Degree or Coding Certification or minimum 3-5 years coding, or auditing and claims investigation background
Skills : Demonstrated experience in Microsoft Applications required. Excellent organizational skills, ability to work independently, self-motivated and demonstrated attention to detail. Ability to speak/present facts clearly, maintain confidential information as well as track and trend pertinent data.
Years of Experience : 3 – 5 years relevant experience
License : Valid driver’s license and the ability to travel independently throughout the Plan’s service area.
Preferred Qualifications:
Skills : Mid to Advanced level Excel skills (Vlookup, pivot, charts, etc.)
Years of Experience : 5+ years relevant experience, Coding and or Billing background in an acute or ambulatory setting
License : Certification through AAPC or AHIMA
Working Conditions:
Personal Protective Equipment: General office environment
Physical Demands: Ability to move between company workstations, floors and departments; ability to communicate on telephones; ability to operate general office equipment including computers.
The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact (see below)
Equal Opportunity Employer/Drug-Free Workplace
