Intake Specialist - J29, Inc

Overview:

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

 

Position Purpose:

Performs routine accounting work. Provides lead work and subject matter expertise through technical support and one-on-one training. Computes, classifies, records and maintains numerical data in accordance with regulations, policies and procedures to keep financial records complete and provides general office duties. Ensures the completeness of the dispute before it goes to a Dispute Resolution Reviewer (DRR) decision-maker, including, but not limited to, confirming the administrative fee has been received and accepted, prior to passing the dispute to the DRR for resolution. Works under moderate supervision, with moderate latitude for the use of initiative and independent judgement.

*CREDIT CHECK WILL BE REQUIRED FOR THIS ROLE*

Essential Responsibilities:

· Serves as a lead staff member and subject matter expert for the Dispute Resolution Analysts and/or Clerks.

· Reviews documentation and communicates with insurance carriers and providers as needed.

· Reviews and analyzes medical billings for appropriate payment classifications.

· Uses subject-matter knowledge and judgment related to pricing disputes to resolve processing issues.

· Accesses electronic financial payment information to answer general questions as well as those related to specific accounts.

· Assists with questions related to the contract or project. This may include, but is not limited to, corrections and detailed explanations as to how to properly comply with Centers for Medicare & Medicaid Services (CMS) guidelines.

· Assists in preparing bank deposits and posting customer payments (Venmo, Cash App, Apple Pay or checks).

· Confirms payments and posts payments to dispute file.

· Checks figures, postings and documents for correct entry, mathematical accuracy, and proper codes.

· Operates computers programmed with accounting software and spreadsheets to enter, store, retrieve and analyze information.

· Assists in facilitating meetings, including staff meetings to discuss quality measures and provide training.

· Enters data into internal or contract specific systems.

· Provides training for staff relative to systems and procedures.

· Monitors several tasks and addresses errors using work instruction manuals.

· Identifies and logs errors that cannot be resolved using existing work instructions.

· Assists in completing and submitting various reports to ensure compliance with regulatory and contractual obligations.

· Reconciles or notes and reports discrepancies found in records.

· May provide providers, patients, and/or internal staff clarification as to what is being requested and any missing information needed.

· May provides assistance to patients on fee payment resolution.

· Participates in special projects and performs other duties as assigned.

Minimum Qualifications

Education

· High School diploma or equivalent

Experience

· Four (4) years general office experience

o College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)

· General accounting, preferred

· Healthcare Industry, preferred

Working Knowledge of

· Applicable laws, rules and regulations

· Applicable systems and applications

· Automated record-keeping methods

· Customer service concepts

· Inventory control procedures

· Medicare policy, guidelines, regulations, statutes, rulings and CMS policies

· Medical Terminology

· Research techniques

· Basic accounting principles, procedures and terminology

· Revenue deposit procedures

· The responsibilities associated with administrative practices and procedures to include writing, editing and report writing techniques, record keeping and records management

Proficient Skill in

· The use of basic mathematical fundamentals

· Customer service/customer relations

· Researching, analyzing and interpreting policies and state and federal laws and regulations

· Preparing and maintaining records, files and reports

· Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency

· The responsibilities associated with administrative and office procedures to include the use of proper business telephone etiquette, internal communication strategies and use of basic office equipment

· The responsibilities associated with administrative practices and procedures to include writing, editing and report writing techniques, record keeping and records management

· The use of personal computers and applicable programs, applications and systems

Ability to

· Maintain effective working relationships with individuals and groups

· Analyze and organize technical data

· Interpret applicable information

· Perform statistical analysis

· Prepare and maintain records, files and reports

· Research, analyze and interpret policies and state and federal laws and regulations

· Multitask and meet deadlines

· Exercise logic and reasoning to define problems, establish facts and draw valid conclusions

· Make decisions that support business objectives and goals

· Identify and resolve problems or refer issues appropriately

· Communicate effectively verbally and in writing

· Adapt to the needs of internal and external customers

· Show integrity and ethical behavior; respect confidentiality, business ethics and organizational standards

· Assures compliance with company policies, procedures, and guidelines including cybersecurity, regulatory, contractual and accreditation entities

Work Environment

Requires working in an office/cubicle environment; sitting, standing, walking, bending, twisting and/or reaching. Requires repetitive movement; ability to lift, carry or move up to 25 lbs. when transporting work equipment or materials. May require ability to operate a motor vehicle; the ability to travel by motor vehicle and commercial airline. May require overnight travel.

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