CareCentrix
Overview
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.
Responsibilities
In this role, you will:
- 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
- Is able to support escalations and research claims in addition to solving queue based edits
- 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
Qualifications
You should reach out if you have:
- HS diploma or equivalent
- Minimum of one year CCX claims experience
- 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
- Excellent communication (verbal/written), organizational and interpersonal skills.
- Ability to manage multiple tasks, be detail-oriented, be responsive, and demonstrate independent thought and critical thinking.
What we offer:
- Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
- Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
- Advancement opportunities, professional skills training, and tuition Reimbursement
- Great culture with a sense of community.
CareCentrix maintains a drug-free workplace.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.