This position receives/responds to provider authorization issues and/or revenue cycle management inquiries on claim issues. Researches information by reviewing health plan eligibility, patient notes, and authorizations to determine appropriate resolution. Works with internal Care Service Center team or RCM – revenue cycle management teams to identify areas of opportunity and recommend solutions. Completes special assignments and analyzes provider requests. Assists other departments and interacts directly with providers.
Responsibilities
In this role you will:
- Handle various provider authorization projects which include researching, resolving, and documenting provider authorization issues.
- Handle RCM authorization and intake changes required for claims and billing processing within a 48 hour turn-around time frame.
- Analyze data and determine if CareCentrix guidelines have been followed when providing authorizations to providers by researching plan, eligibility, and patient authorization information.
- Track errors and communicates to up-line management for coaching and training purposes.
- Create or modify authorizations when necessary based on individual provider and carrier contracts.
- Perform analysis on possible recoupments and processes recoupments.
- Participate in and contribute to performance improvement activities.
- Participate in special projects and performances other duties as assigned.
Qualifications
You should reach out if you:
- Have a High School Diploma plus a minimum of 4 years of experience in medical claims, customer service, claims processing, medical terminology, medical services or equivalent experience required.
- Have expert knowledge of department systems and processes as well as CareCentrix business protocols and relevant legal and regulatory knowledge. Knowledge of Utilization Management and URAC standards preferred.
- Possess effective analytic and communication skills as well as knowledge of HIPAA, The Fair Credit and Collections Act, HCPC, CPT, ICD-9 coding, intermediate competency of Microsoft Office Applications, and mathematical calculations.
What we offer:
- Salary Range: $18-22 / hour plus Corporate Bonus Incentive
- 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.