This role, reporting to the ProviderPay Operations Supervisor, is responsible for the daily management of claims data and coordination for current customers. This role manages paper-based remittance advice, ensuring qualified claims are identified and moved forward in the reconciliation process.
Proactively obtains needed remittance detail from appropriate third-party payers to include in reconciliation process. Conducts routine audits and process flow reviews to ensure accuracy and efficiency. Collaborates with internal team members to research and resolve reported issues for current customers.
Minimum Job Qualifications (Knowledge, Skills, & Abilities):
Requires 3+ years of related experience
Business Experience:
2+ years’ experience in healthcare payment and claims processing or healthcare industry business process.
MS office experience, SQL Query experience.
Strong attention to detail.
Advanced speed and accuracy managing data and data entry.
Education/Training: Associate/ Bachelor’s degree preferred.
Specialized Knowledge/Skills: Managed care experience. Pharmacy operations / claims adjudication knowledge or experience. Pharmacy reimbursement / reconciliation knowledge or experience.
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