Top Data Warehousing Executive oversees and coordinates the design and operations of data warehouse/data mart/business intelligence group. Accountable for all data warehouse systems to ensure that all business objectives are met. Being a Top Data Warehousing Executive establishes standards and ensures that the capture and integration of data from diverse sources results in useful analysis and access by end users. May require an advanced degree of Computer science. Additionally, Top Data Warehousing Executive typically reports to CTO. The Top Data Warehousing Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Comprehensive knowledge of the overall departmental function. To be a Top Data Warehousing Executive typically requires 8+ years of managerial experience. (Copyright 2024 Salary.com)
Claims Data Entry and Mail Coordinator
Department:
Claims
Effective Date:
December 1, 2019
Reports to:
Claims Manager
Direct Reports:
None
FLSA:
Non-Exempt
Working Conditions: Normal, no adverse or hazardous conditions.
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Primary Purpose:
To process the medical claims of the company’s IPA clients pursuant to designated production quotes
for accuracy and productivity benchmarks.
Principal Duties and Responsibilities ( = essential functions):
the appropriate databases.
Apply Action Codes to pend claims (when appropriate).
Answer calls from members, providers and health plans regarding specific claim issues. Route and
redirect calls as necessary. Perform timely follow-up on calls requiring research and call back. Use
MedMC to log incoming call and resolution of the call.
Accurately interpret DOFRs – Division of Financial Responsibility documents that determine who
pays for specific health care services (PDT, health plan or other).
Provide administrative support to Claims Manager or Senior Claims Specialist, including but not
limited to, copying and filing documents, printing and routing incoming claims faxes to the
appropriate recipient.
Treat peers, superiors, subordinates, clients and vendors with fairness, courtesy and professionalism
and contribute to the overall positive work environment of the department and the Company.
Complete other duties as assigned by supervisor.
Job Specifications (KSAs):
Requires the ability to speak, read, write and understand English and other general educational skills
as is generally obtained by completing high school or a GED.
Knowledge of managed care claims processing as is generally obtained through 1 year claims
experience.
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