Sevagan
KRG Technologies Inc.
E-Mail: Sevagan at krgtech
25000 | Avenue Stanford | Suite # 243 | Valencia, CA 91355
Phone : 661-558-0000 EXT- 513|
Job Description
As a Quality Coordinator for Claims Processing, you will be responsible for reviewing all components of member submissions for paper claims. This Quality Coordinator role is essential to ensuring that all claims are properly processed to ensure the correct parties are billed for claims. You will review submitted member data in a workflow system (MedForce)against data in AS400 to ensure all claims data has been properly entered. The Quality Coordinator will also perform data mining to review the accuracy of member payments.
Additionally, the Quality Coordinator will:
- Review and validate claims elements captured in the adjudication system against the claims forms and supporting documents submitted as detailed in the P&P’s and SOP
- Identify missing/incorrect claims elements and send claims back to Claims Processors for correction, with an emphasis on critical claims fields which result in non-conformance per regulatory guideline
- Validate corrections made by the processors to ensure 100% accuracy
- Validate claims payment contents – paid to, amount paid, and payment type
- Collaborate with the Paper Claims Processing Team and Supervisors to identify specific opportunities for improvement
- Raise and report errors to team supervisors. Also, identify trend sand learning opportunities based on errors tracked
- Adhere to specified TAT as defined by the business
- Maintain a high level of self-learning to be up to date on the current P&P, SOP’s and regulatory guidelines and be available to conduct refresher and follow up training whenever required
*
Required Qualifications
- 2+ years of experience in pharmacy/Medicare Part D claims processing or audit - Quality auditing experience - Proficiency in MS Word and MS Excel
*Preferred Qualifications
- Medicare Part D or related industry knowledge
- Exposure to CMS Member Reimbursement Request Forms- Analytical thinking and rational decision making skills - Experience MedForce or AS400 preferred
Additional InformationStrong Experince on Claims
Top Skills
What We Do
Established for more than two decades, KRG Technologies, Inc., headquartered in Valencia, CA, is a distinguished leader in Workforce Solutions, Microsoft Technology Solutions & Services, and Edge Computing (iOT) across the USA, Canada, Dubai, and India. Recognized as a Great Place to Work for two consecutive years, and a five-time honoree by Inc5000, and certified with ISO 9001 and 27001, KRG Technologies has demonstrated a steadfast commitment to excellence and innovation in the Information Technology & Services industry.
KRG specializes in providing all-around workforce solutions, developing advanced digital applications, Microsoft solutions, and Edge Computing(iOT) for smart spaces. Well-known for getting things done, we focus on finishing work on time and sticking to the budget without sacrificing quality. We are good at making cost-effective solutions that not only meet but go beyond what the client wants, making sure everything goes smoothly and gets the best results.
The purpose of KRG’s existence is ‘employment creation’ and we want to have long-term relationships with our employees and clients. To do this, we follow the important principles of being honest and transparent.
We offer customers the advantages of:
• Software development processes - flawless execution and project management.
• Leveraging a combination of proven onsite and offshore
• Professional Services Unit to augment your onsite team capacity/capability
• Commitment to meet your objectives "on time - within budget"
• Aggressive Pricing & Proven Track Record.
