This position receives/responds to provider inquiries on claim issues. Researches information by reviewing plan, eligibility, and authorizations to determine appropriate resolution. Works with CSC or RCM to identify areas of opportunity and recommend solutions. Completes special assignments and analyzes provider requests. Assists other departments and interacts directly with providers.
• Handles various inbound or outbound provider calls which include researching, resolving, and documenting issues.
• Handles RCM authorization and intake changes required for claims and billing processing within a 48 hour turn-around time frame.
• Analyzes data and determines if CareCentrix claims processing guidelines have been followed correctly by researching plan, eligibility, and patient authorization information.
• Tracks claim detail errors and communicates to up-line management for coaching and training purposes.
• Participates in and contributes to performance improvement activities.
• Participates in special projects and performances other duties as assigned.
Requires a HS diploma or equivalent; up to 1 year of previous related experience; or any combination of education and experience, which would provide an equivalent background. Two years of customer service, claims processing, medical terminology, medical services or equivalent experience required. Knowledge of basic spreadsheet / word processing / data entry and basic math skills required. Knowledge of Claims Management and URAC standards preferred.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.