Job Description
Summary
The PDR Clerk is responsible for managing Health Plan audits and demands, ensuring timely and accurate responses, and maintaining meticulous records. This role involves handling communications via email and fax, data entry, and collaboration with coordinators and other team members.
Duties and Responsibilities
· Health Plan Demands Management:
o Receive health plan demands via email and fax.
o Enter demands into Smartsheet with accuracy and attention to detail.
o Assign demands to the appropriate coordinator with a specified due date.
o Monitor the coordinator’s responses and ensure timely communication back to the health plan.
o Provide a preliminary Explanation of Payment (EOP) if the claim is not reprocessed.
o Deliver the final EOP once the claim is paid.
o Supply the original EOP to the health plan if the demand is upheld.
· Health Plan Audits:
o Receive audit assignments via email.
o Pull all required documents depending on the health plan specifications.
o Combine all relevant documents into one comprehensive file.
· Communication and Collaboration:
o Maintain clear and professional communication with health plans and internal coordinators.
o Ensure all correspondence is handled promptly and efficiently.
o Collaborate closely with team members to ensure smooth workflow and accurate data management.
· Record Keeping:
o Maintain accurate and up-to-date records of all health plan demands and audits.
o Ensure all files are organized and accessible for future reference.
· General PDR assignments:
o May be asked to work on various PDR tasks as delegated by the Supervisor.
Minimum Job Requirements
· High school diploma or equivalent; additional education or certifications in healthcare administration or related fields is a plus.
· Proven experience in a clerical or administrative role, preferably within the healthcare industry.
· Proficiency with Smartsheet and other data entry tools.
Skill and Abilities
· Strong organizational skills and attention to detail.
· Excellent written and verbal communication skills.
· Ability to manage multiple tasks and meet deadlines.
· Familiarity with EOPs and health plan processes is advantageous.
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