A division of Utah Retirement Systems, PEHP is a non-profit trust with the vital job of providing health benefits to Utah’s public employees and their families.
Reviews and analyzes payments on medical, dental, and pharmacy claims as well as third party liability cases to identify overpayments according to guidelines. Corresponds with members, providers, and insurance companies to collect overpayments in a timely and efficient manner.
ESSENTIAL DUTIES & RESPONSIBILITIES
Education and Experience
High School diploma and two (2) years of progressively responsible experience performing Medical, Dental and Pharmacy claims; or an equivalent combination of education and experience.
A minimum of one (1) year with PEHP-specific experience in claims processing, customer service, and various administrative audit functions is preferred.
Knowledge, Skills, and Abilities
Requires considerable knowledge of medical, dental, pharmacy, and Medicare supplement claims adjudication policies, procedures and processes; intricacies related policy provisions and CPT and ICD.9 coding; of COB provisions and regulations; of medical and dental terminology' of CPT computer operations; of various office management systems related to alpha and numeric record keeping; interpersonal communication skills; telephone etiquette; personal computer operations (PC/MS DOS) and various program applications; basic bookkeeping; routine negotiation techniques; working knowledge of 10 key operation; basic mathematics; basic public relations.
Must have the ability to analyze information and draft technical reports and make recommendations; communicate effectively verbally and in writing; ability to follow written and verbal instructions; establish and maintain effective working relationships with professionals, executives, department heads, co workers and the public; work independently and deal effectively with stress caused by work load and time deadlines.
Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing. Common eye, hand, finger dexterity required to perform essential functions.