Job Description & Responsibilities:
Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables. Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices. Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances. Clear payment variances, resolving differences, and initiating corrective action. Guide/instruct and support agency personnel encompassing all aspects of insurance and non-Medicare claims processing. Prepare input data forms to update computer system. Review and communicate with agencies to educate them about expectations for clean claims.
Qualifications
Required Experience/Skills: High School Diploma or the equivalent Minimum of two years medical claims processing experience preferred Knowledge of healthcare collection procedures and microcomputer software/hardware preferred Effective analytical and communication skills Additional Information: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Contact:
Employer: HUMANA
Location: Remote, Georgia
Link: https://careers.humana.com/us/en/job/R-366050/Healthcare-Claims-Denials-Specialist