Responsibilities & Duties:Claims Processing and Assessment:
- Evaluate incoming claims to determine eligibility, coverage, and validity.
- Conduct thorough investigations, including reviewing medical records and other relevant documentation.
- Analyze policy provisions and contractual agreements to assess claim validity.
- Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
- Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
- Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
- Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
- Ensure compliance with company policies, procedures, and regulatory requirements.
- Maintain accurate records and documentation related to claims activities.
- Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
- Identify opportunities for process improvement and efficiency within the claims department.
- Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
- Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
- Generate reports and provide data analysis on claims trends, processing times, and outcomes.
- Contribute to the development of management reports and presentations regarding claims operations.
Top Skills
What We Do
For over 25 years, Harris Healthcare has been rising to the challenge of bringing together the most innovative and sustainable solutions for today’s ever-changing healthcare environment, in order to improve patient care and safety. Each one of our solutions brings organizational efficiencies on its own. Powerful synergies are achieved when multiple solutions are implemented together. The Harris Healthcare portfolio includes the following solutions:
♦ HARRIS Flex - an enterprise-level EHR solution that improves patient safety and clinical workflows. It includes a full complement of applications integrated in one single database, provides solid clinical decision support to your clinicians and helps standardize care while enforcing protocols and best practices at any Healthcare Organization. HARRIS Flex conveys the digital solution’s flexibility and strength.
Healthcare organizations are continuously faced with new challenges and situations and require flexible EHR’s that can be rapidly adapted to their evolving clinical practice. Contrary to other EHR solutions which are inflexible and where customizations require costly support from the vendor, HARRIS Flex gives you the freedom to "flex" your EHR as you need it entirely on your own.
The enhanced HARRIS Flex solution comes with new functionality including:
♦Flex Telehealth which enables virtual visits directly from within the EHR/EPR, and
♦Flex Clinical Insight which facilitates extraction and analysis of your EHR/EPR data to improve your processes and outcomes.
♦ SynergyCheck – a proactive interface monitoring solution watching over Clinical, Financial and other interfaces 24/7 to ensure data is flowing between systems
