Account Assistant 4, Claims

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Overview

In 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has approximately 49,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world and is committed to an inclusive workplace.  We are celebrating over 50 years of service to the Yale community.

Our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150+ providers. It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy.

The Account Assistant processes Claims for the Yale Health.  Provides information and assistance to patients, clinicians and members of the Yale Community on Claims processing and reimbursement policies. Responsibilities include:

Serve as a principal source of information on Yale Health Plan benefits, contracts, and claim status to members, clinicians and administrative staff.

Process IP and OP claims consistent with eligibility, referrals, benefits and contracts in the IDX system.  Ensure payments consistent with benefits and contractual arrangements.

Run reports to identify pended referrals and, using coverage policies, adjudicate consistent with the policy.  Communicate decisions to members, providers and clinicians. 

Telephone, emails and other written correspondence for follow up to members and providers.

Assist in the development of policies on coverage regarding claims.

Investigate and resolve problem claims with vendors and members.  Work with collection agencies to recall accounts, when indicated.  Seek the advice and direction of the Manager when necessary.  Assist with final review and disposition of problem claims.  Recommend changes to enhance systems and operating procedures.

Document interactions with members and vendors in the Customer Service Module of IDX.

Generate voucher reports, explanation of benefits, create Accounts Payable electronic file and submit to Workday for check generation.  Generate status report of file submission.

Research vendor payment setup in IDX and Workday .  Complete and submit Vendor Set Up Request Forms to the Manager for review and authorization when indicated.

Enter financial transactions in the Workday Financial System for interdepartmental transfers.

Compose form letters and correspondence.  Perform clerical activities in support of department operations. 

Schedule:  Full-time (37.5 hours per week). The typical schedule is Monday-Friday, 8:30 a.m. to 5:00 p.m. Occasional evenings, weekends, holidays, and recess periods may be required, and overtime may be necessary.

Hybrid schedule will be considered after successful completion of probationary period and initial competency assessment.

Required Skills and Abilities

1.  Ability to organize, prioritize and multi-task.  Excellent customer service skills. Strong interpersonal skills and ability to work effectively with a wide range of individuals.

2.  Current claims processing skills.  Knowledge of medical terminology as well as ICD-10, HCPC and CPT coding.

3.  Ability to function independently with well-developed problem solving skills. Proficient with Microsoft Word and Excel.

4.  Excellent attendance and reliability.

5.  Ability to handle issues of a sensitive and confidential nature with tact and discretion.

Preferred Skills and Abilities
Experience with IDX or EPIC and Workday systems. Three years of recent claims experience.

Principal Responsibilities

Required Education and Experience

Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate's degree, or an equivalent combination of experience and education.

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Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working a healthcare setting who have the potential for direct or indirect exposure to patients, human research subjects or infectious materials including body substance, contaminated medical supplies, devices and equipment, surfaces, or air.  HCW have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.

Posting Disclaimer

The hiring rate of a role is determined in accordance with the provisions outlined in the respective collective bargaining agreement.

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties through  their hiring department.

The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).

Note

Yale University is a tobacco-free campus.