Posted: Saturday, September 30, 2017 10:38 AM
Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Responsibilities: The Provider Claims Services Rep is responsible for responding in a timely, professional and courteous manner to all customer needs. This includes provider phone calls or correspondence regarding benefit, eligibility, and other provider issues. Reviews and adjudicates claims based on provider and healthplan contractual agreements and claims processing guidelines. Suspends claims requiring additional information and/or special handling; initiates action to obtain required information. Forwards claims requiring external department intervention to the appropriate department or person. Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance. Reviews and verifies quality audit reports. Reconciles audit discrepancies, corrects in system and make appropriate changes to avoid recurrence. Maintains thorough knowledge of claims process systems, its databases and subsystems. Responds to and resolves provider and healthplan claim inquiries. Monitors and tracks aged, pended, and open reports to maintain timeliness in claims processing. Inputs claims into the system for appropriate tracking and processing. Documents file, as appropriate, to support payment decision. Serves as a Subject Matter Expert and conducts training as required. Conducts cross training to staff as required. Actively participates in user acceptance testing functions, such as test script development, testing and documentation of test results. The ideal candidate will have the following: High School diploma or GED required. Associate's Degree preferred Minimum of four (4) years of experience in Claims processing and Call center Prior experience in the healthcare or managed care industry preferred. Minimum 45 wpm typing skill preferred. Excellent judgment and decision-making skills in dealing with complaints and sensitive requests required. Ability to use PC applications in a window based.
• Location: Jacksonville
• Post ID: 18901742 jacksonville