Duties/Responsibilities:
Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.
Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with recommended solutions.
Follows up to ensure outstanding issues are resolved and to increase and promote overall satisfaction.
Compiles recurring issues to help educate teams on error prevention.
Completes documentation in Patient Health Information database (CCMS) and in accordance with all other company procedures.
Additional duties as required.
Minimum Qualifications:
HS Diploma or GED from an accredited institution.
experience with Outlook and MS Office.
Good communication skills.
Strong attention to detail.
Preferred Qualifications:
Associate's Degree or Bachelors degree.
Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese.
Relevant previous work experience including but not limited to claims, service authorizations, health insurance, and Medicaid managed care products.
Healthcare industry experience
Experience working with Claims and Providers.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
