Claims Specialist (Full-Remote) at Tabula Rasa Healthcare in Moorestown, New Jersey

Job Description:

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC's lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are. Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

JOB TITLE: Claims Specialist

JOB OBJECTIVE: The Claims Specialist is responsible for acting as a first-line resource for external clients regarding our services and product lines, and ensuring the necessary information is disseminated to the applicable resources. Candidates will develop, support, and strengthen client relationships alongside Account Management, address needs/concerns and assist in establishing solutions to improve operations in various areas, having routine contact with partners. Additionally, this role will coordinate implementations and training as needed, and prepare reports and documentation.

This position also assists with various internal tasks that ensure a high level of overall client satisfaction.

ESSENTIAL JOB FUNCTIONS:

• Act as a first-line contact to external clients and assist in answering questions and/or triaging concerns to other teams and associates.
• Develop, support and strengthen client relationships alongside Account Management; Address concerns and establish strategies for improving operations in various areas.
• Coordinate with internal teams to find and/or suggest solutions for client concerns or requests, or to improve service offerings.
• Facilitate and/or participate in regularly scheduled calls (pre- and post-implementation).
• Coordinate and conduct phone and email outreach.
• Coordinate the submission of reporting for client and for appropriate management to ensure critical deadlines are met.
• Perform risk assessments/quality reporting, and monthly reporting, as directed.
• Maintain and document client updates in CRM systems (i.e. approvals, contract requirements, customized requests, visits, education, training, phone calls, e-mails, etc.)
• Ensure regulatory compliance between TRHC and clients; and track updates/changes for incorporation into policies and procedures.
• Ensures that HIPAA guidelines are followed in every communication with clients
• Monitor client needs and recommend additional services and/or improvements to current services, when appropriate
• Assist the client with navigating and optimizing the use of service offerings and reports
• Assess client needs based on structured assessments every quarter
• Maintain current knowledge of PACE, Medicare Advantage, and Managed Long-Term Care (MLTC)
• Maintains Client and Internal Contact list
• Ensures customer satisfaction by understanding and adhering to all policies and procedures
• Communicates clearly and concisely with sensitivity and a sense of urgency to address client needs
• Maintains courteous, helpful, and professional behavior.
• Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers, and employees.
• Maintains safe working environment

• Attend department and company meetings and educational programs upon request.
• Perform administrative duties as required.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

QUALIFICATION REQUIREMENTS: These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION:

• Required: Associate's degree in related field or formal training beyond high school


• Preferred: Bachelor's degree in related field

EXPERIENCE:

• Three (3) years of professional work experience in a health plan setting in account management, client relations, customer service, or operations is required
• One (1) to three (3) years of health insurance claims experience required
• Professional experience in building client relationships and problem solving is required

• Knowledge of the complexities of PACE is strongly preferred
• Knowledge and experience using current computer technology, and a strong knowledge of Excel and Word; ability to easily adapt to new systems

OTHER SKILLS and ABILITIES:

This job operates in a remote environment. Requires manual and finger dexterity and eye-hand coordination to use computer and office equipment. Must be able to sit for extended periods of time at a computer. Must be able to communicate verbally and in writing. Must be able to handle a multitude of projects simultaneously, work well under pressure, meet deadlines and maintain confidential and sensitive information. Must be an independent thinker who is willing to take on extra responsibility and work independently with little supervision. Must be able to work well with others, at many levels and of many backgrounds.

#LI-remote

Expected Hours of Work: This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. This may be considered a hybrid position based on manager discretion.

Travel: None

Supervisory: None

***This is a remote position. Adequate internet speeds and a suitable home-office environment are required for this position. All new team members will be bound by the "Teleworking Agreement' and must continually meet the terms of the agreement to maintain remote work status.

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Other details

• Pay Type Salary