Position Purpose:  Process claims in the Zero Queue and maintenance of provider contracts.

Responsibilities:

• Process claims in the Zero Queue

• Research, load and maintain non-par provider records 

• Research providers in external platforms

• Load and maintain participating provider contracts

• Update codes (i.e. ICD-10, CPTs, HCPCS), fee schedules, claim rules, etc.

• Review provider data integrity reports

• Communicate with providers as required

• Communicate with internal departments

• Performs additional duties and responsibilities as assigned by management

  Qualifications:

• Experience in Medicare Advantage operational and regulatory guidelines

• Knowledge of provider contracts and reimbursement methodologies

• Understanding of claims processing and medical terminology is desirable

• Excellent organizational and communication skills

• Strong analytical and critical thinking skills

• Experience working in a team-oriented, collaborative environment

• Computer literacy: MS Excel, MS Word, etc.

  Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

  No Third Party Agencies or Submissions Will Be Accepted.   

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP   

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

Powered by JazzHR