Excellent employment opportunity!
About Us:
CareMore is looking for a dynamic individual to join our team! CareMore is a leading healthcare system specializing in providing a complete, pro-active health care experience to Senior Americans. CareMore strongly believes in our innovative and caring vision to lead the next generation of health care and we look for candidates that share in our passion.
As a leader in senior healthcare for over 20 years, our vision is to significantly improve the lives of Medicare recipients throughout California by employing a dedicated staff of professionals who are passionate about changing lives. When you join CareMore, we’ll give you every opportunity to make a real difference.
Be More with CareMore.
CLAIMS APPEALS COORDINATOR
CLICK HERE TO APPLY ONLINE!
Job Description:
Point of contact for submission/resolution of Claims Appeals and/or Provider Disputes in the Claims Department. Conducts all pertinent research in order to evaluate, adjudicate and address certain types of incoming Claims Appeals and/or Provider Disputes accurately, timely and in accordance with all established regulatory guidelines and provider contract language. Interfaces with internal departments as it may relate to responding to inquiries and verifying pricing. Works with Manager to document and identify core reasons for the appeals and upon Manager’s direction tracks, trends and documents all issues. Prepares and assist with reports for team. Maintain confidentially as required. **temporary position**
Essential Duties and Responsibilities:
- Determine accuracy of claims adjudication to include, contract interpretation, benefit limitations, correct coding edits and determining claim was paid in accordance with all industry guidelines and regulations.
- Provide expertise and general claims support to teams in reviewing, researching, investigating, processing and adjusting claims.
- Analyze and identify trends and provide reports as necessary.
- Provide immediate feedback on any issues that require immediate escalation to management.
Education and Experience:
- High school diploma or general education degree (GED); or equivalent combination of education and experience.
- 5 + years of claims processing and an additional several years of either auditing or analyst type of role.
- Knowledge of Medicare reimbursement policies & procedures or familiarity of claims processing for an HMO.
- Ability to interpret provider contracts.
- Intermediate level knowledge of Microsoft Word and Excel.
- Sound analytical skills.
- Strong organizational skills and attention to detail.
- Must be able to work independently
- Proven ability to perform well in a production environment.
Compensation/Benefits:
CareMore offers a comprehensive benefits package to include medical, dental, vision, life, long term disability, flexible spending accounts, 401(k), PTO, and much more.
AA/EOE M/F/D/V
Watch how our CareMore Employees care more, in the video below.
