Review and monitor adjudicated claims for file submission and upstream processing
Communicate with provider agencies on claims submission, denial management, and system updates
Facilitate training of providers and provide intermediate technical assistance
Analyze available billing requirements, policies, procedures, and desk references to ensure proper protocol is practiced to accurately process claims
Demonstrate and utilize advanced analytical skills to process complex claims
Monitor and resolve technical issues within the Claims system
Communicate and conduct liaison work across multiple departments to resolve claims denials/issues
Provide training, education, and technical assistance to provider agencies
Requirements
High School degree or equivalent and four (4) years of related experience (in customer service, claims processing, research/analytics, or communications)
Or Bachelor’s degree from an accredited college or university in related field and two (2) years of experience (in customer service, claims processing, research/analytics, or communications)
Knowledge of Microsoft Office, including Excel, Word, Outlook
Working knowledge of healthcare services and systems
Working knowledge of functions provided by Provider Networks, Utilization Management, Accounts Payable, Contracts, and Care Management
Knowledge of common claims denials and sources for correction
Knowledge of Medicaid and IPRS rules
Knowledge of laws, legal codes, precedents, government regulations, and MCO policies and procedures
Knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations
Excellent customer service skills
Proficiency in written and oral communication
Benefits
Medical
Dental
Vision
Life
Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
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