Our Provider Claims Liaison is a Japanese-English biligual position where you can utilize your language and global experience.

This role is responsible for receiving, reviewing, and verifying provider claims to ensure charges billed comply with authorized services and insurance carrier specific billing procedures. This position also enters provider claims into the company’s system for further processing.

Essential Job Duties and Responsibilities:

• Receives provider invoices (medical claims) via email, post, e.t.c. and effectively logs the invoice information in Excel tracker daily.
• Reviews, and validates medical claims by verifying that billed charges correspond to services authorized in Guarantee of Payment (GOP) letters.
• Records medical claims in BiGGeR system for timely payment processing.
• Handles provider inquiries received by email and phone, investigates the concerns and delivers timely resolutions in a professional manner.
• Closely works with Operations team, Medical Benefit Reviewers, Billing and Network Service teams as necessary to effectively resolve queries and outstanding issues.
• Maintains effective communication with supervisory and other management teams and provides timely updates on situations that impact productivity and efficiencies.
• Ensures protection of private health and personal information by adhering to all HIPAA and PCI compliance regulations for monitoring billing and reimbursement related data.
• Actively participates in day-to-day office activities, including variety of meetings and task force group to improve processes.
• Completes additional, related duties as assigned by Payment Manager as need.

Requirements:

Exeperience:

• Experience demonstrating Customer Service skills in private sector
• Claims/billing Experiences
• Knowledge of hospital/medical administration a plus
• Proficiency in Microsoft Office applications (Excel, Work, Outlook, PowerPoint)
• Medical terminology certification a plus
• Experience with Electronic Data Interchange (EDI) a plus

Langauge & Education

• Japanese: Native level
• English: Business level
• Bachelor's degree in any field

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