Reviews and investigates claims, enters claims into the CareCentrix computer system, matches claim data with the appropriate authorizations and determines correct claims payment, denial or adjustment. Analyzes resolves or refers questionable claims and authorizations or system issues as appropriate. Completes special assignments and analyzes provider requests. Guides team towards the successful collection of invoice processing activities to ensure receivables are reimbursed on an accurate and timely bases. During elevated collector activates, works directly with the payer’s point of contact, internal and external customers and other contract clients toward effective and efficient collection results. Mentors Claim Adjudicators and Claims Analysts and provides additional management support including inventory control and system testing. Works under general supervision.
ATTRIBUTES / QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
High School Diploma plus four years of claims processing, accounts payable, general accounting or equivalent experience required. At least two years of experience directly related to medical claims processing along with evidence of superior performance required. Broad knowledge of insurance and/or accounting procedures and PC software/hardware is necessary. Excellent analytical and communication skills also required. Knowledge of Utilization Management and URAC standards.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.