Reviews and investigates claims and makes claim payment determinations.
Successfully processes claims into CCX systems and matches claims data with the appropriate authorizations as necessary.
Determines correct claims payment or denial through the use of job aids, DLPs and basic claims training.
Identifies and evaluates questionable claims and authorizations or system issues as appropriate.
• Review of electronic claims and resolves computer generated edits
• Determine correct payment or denial amounts and document notes as appropriate
• Identifies and refers questions to a Team Lead or Senior associate as appropriate
• Exercises good judgment, interprets medical claim data and contracts, and remains knowledgeable in related company policies and procedures
• Works under close supervision
• Is expected to achieve production and quality targets as set by the department
• Adheres to all Carecentrix policies which may include but is not limited to; Mandatory HIPAA privacy program, Business Ethics and Compliance, Attendance and any additional Corporate or departmental policies
• 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.
• Experience with claims processing, medical terminology, medical services or equivalent experience helpful.
• Knowledge of basic spreadsheet / word processing / data entry and basic math skills helpful
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.