In this role, you will report to the Compliance Manager or his/her successor. This position will specialize in Hawaii Medicaid claims processing. The Claims Specialist will be responsible for reviewing, preparing, and submitting claims to Hawaii Medicaid in accordance with our contract. The claims specialist will be responsible for reviewing, preparing, and submitting invoices to NET providers leasing tablet devices and other IntelliRide Hawaii clients.
Working on location Monday through Friday, 10:00 AM to 7:00 PM
Answer NET Provider Claims Inquiries and Reconciliation requests
Clear Individual Provider Driver Logs within 3 business days of receipt of clean claim
Send Notice of Missing Information to NET Providers or Denial letter, if applicable, within 15 business days of receipt of documentation
Archive, Print, and Mail daily Client Welcome Letters and Self-Service User Guides
Assist providers with adjustment requests
Ensure that claims are submitted to DHHS in accordance with 471 NAC
Create 837P files for all eligible NET Providers and submit to DHHS within 10 days of receiving a clean claim for 90% of all claims
Create 837P Administrative Fee files for IntelliRide and submit to DHHS
Retrieve 999, Error, and 227CA files from DHHS and process
Retrieve 835 file from DHHS and process
Prepare, maintain, and send monthly tablet lease invoices to NET Providers
Prepare, maintain, and send monthly service invoices to IntelliRide Hawaii Clients
Review Monthly Paid Claims Report from DHHS and compare to submission
Complete post claims audit
Education, Licensing, and Certifications:
Skills and Knowledge Required:
Ability to read, comprehend and understand maps
Ability to read, understand, interpret, and explain transit system operating rules, regulations, policies, phases and routes
Basic math, writing, and computer skills
Ability to communicate via telephone with clear speech and a pleasant phone manner Travel requirement (as a percent): <5% for occasional meetings
Must be able to work shifts or flexible work schedules as needed.
100% of work is accomplished indoors and in air conditioned or well ventilated facilities
Work is accomplished in an office or in a cubicle space equipped with a telephone and computer.
The employee is generally subjected to long periods spent sitting, typing, or looking at a computer screen.
Based near Chicago, Transdev is the largest private-sector operator of multiple modes of transit in North America, including bus, rail, streetcar, paratransit, and shuttle services. Transdev is committed to being the trusted partner of cities and transit authorities through quality execution and innovations in mobility. Its parent company, Transdev Group, is a leading global operator and integrator of mobility operating in 17 countries and provides passengers every day the freedom to connect to what they care about in their cities.www.transdevna.com
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Transdev is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, national origin, age, disability, veteran status, genetic data, gender identity, sexual orientation, religion or other legally protected status, or any other classification protected by federal, state, or local law.
_EEO is the Law Poster: http://www1.eeoc.gov/employers/poster.cfm_
Drug free workplace
If based in the United States, applicants must be eligible to work in US without restrictions for any employer at any time; be able to pass a drug screen and background check.
Job Locations US-NE-Omaha
Posted Date 2 weeks ago (3/30/2021 12:08 PM)
Requisition ID 2021-14077
Position Category Customer Service/Call Center/Dispatch/Reservationist/Scheduler
Internal Reference 402