HMO Liason

Job Summary: 

Works closely with various departments to ensure claims support and administrative functions are optimized in order to support Client Accounts.   

Principal Duties and Responsibilities:  

• Acts as a Liaison between the company and the HMO vendors 

• Works in collaboration with Claims Examiners 

• Works closely with Account Management and Client Service Coordinators on HMO assigned claims 

• Is responsible for the updated maintenance of the UHI file 

• Provides support functions to HMO assigned Claims Examiners and Account Management 

• Responsible for uploading provider claims to the HMO Client Portal 

• Monitors uploaded HMO claims to ensure claims are returned to the company 

• Responsible for initiating internal adjustments on claims 

• Responsible for initiating and following-up on investigations to resolve claims discrepancies via HMO Client Portals 

• Attends biweekly meetings, if initiated by HMO vendor  

• Monitors aging report for HMO claims 

• Schedules training sessions for Claims Examiners on HMO processes 

• Responsible for uploading member statements to the HMO Client Portal 

Required / Desired Knowledge, Experiences and Skills: 

• Knowledge and experience in healthcare and insurance field or any other field related to the industry.    

• Proficient in GMMI Policies and Procedures  

• Proficient in HMO Client Portals 

• Basic knowledge of all aspects of processing claims 

• Extended knowledge of medical bill screen & network repricing system 

• Proficient in client eligibility websites and listings for assigned clientele 

• Ability to manage and prioritize multiple tasks   

• Excellent interpersonal skills necessary to interact positively with clients, providers and professional staff 

• Must represent the organization in a professional and knowledgeable manner. 

• Computer skills essential to manage correspondence, database maintenance, spreadsheet analysis and for information entry / retrieval from the CostCare system.  

Education/Certifications: 

High School Diploma or Equivalent

Physical Working Environment: 

While performing the duties of this job, the employee is required to stand; walk; sit for long periods of time; use of hands to grasp, handle, or feel; reach with hands and arms; finger dexterity; talk; hear. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. 

The above statements are intended to describe the general nature of work being performed by people assigned to this classification.  They are not to be construed as an exhaustive list of all responsibilities, duties and skills required of employees so classified. 

GMMI is an Equal Opportunity Employer M/F/Disability/Veteran