Description:
- reviews, researches and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines.
- May be required to learn multiple Medicaid plans.
- Works to research and resolve encounter errors
- Ensures all compliance requirements are met.
- Identifies and reports possible claim overpayments, underpayments, scanning issues and any other irregularities.
Requirements:
- 2 years Medical Claims processing experience adjudicating claims (Commercial, Medicaid, Medicare, etc.)
- Experience in a production environment.
- Analytical skills, with the ability to research particularly in areas involving rejected claims.
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
- Demonstrated proficiency with personal computer, keyboard navigation skills, and MS Office Suite applications.
- Preferred Qualifications QNXT claims processing experience
- Encounters experience
- Edifecs knowledge.
Benefits:
- Affordable medical plan options
- a 401(k) plan (including matching company contributions)
- an employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings
- tobacco cessation and weight management programs
- confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off
- flexible work schedules
- family leave
- dependent care resources
- colleague assistance programs
- tuition assistance
- retiree medical access and many other benefits depending on eligibility.