Job Description
Role:Remote Facets Claim Processor
Location: Remote
Duration: 12+ Months
Job Description
• We are specifically looking for associates with Medicaid experience and quality/audit experience
• Analyze trends in claims processing issues and identify work process solutions
• Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.
• Audit check run and send claims to the claims department for corrections
• Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
• Collaborate with the claims department to price pended claims correctly
• Document, track and resolve all plan providers' claims projects
• Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
• Identify authorization issues and trends and research for potential configuration related work process changes
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Identify potential and documented eligibility issues and notify applicable departments to resolve
• Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc
Regards,
Rahul Yadav
(408) 560-3+56
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)
DISCLAIMER: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer or if you want to be REMOVED please reply with REMOVE in the Subject line of this email
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law (www.reqroute.com). We are committed to providing exceptional experience. To give feedbackplease email us at support@reqroute.com.
Location: Remote
Duration: 12+ Months
Job Description
• We are specifically looking for associates with Medicaid experience and quality/audit experience
• Analyze trends in claims processing issues and identify work process solutions
• Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.
• Audit check run and send claims to the claims department for corrections
• Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
• Collaborate with the claims department to price pended claims correctly
• Document, track and resolve all plan providers' claims projects
• Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
• Identify authorization issues and trends and research for potential configuration related work process changes
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Identify potential and documented eligibility issues and notify applicable departments to resolve
• Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc
Regards,
Rahul Yadav
(408) 560-3+56
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)
DISCLAIMER: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer or if you want to be REMOVED please reply with REMOVE in the Subject line of this email
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law (www.reqroute.com). We are committed to providing exceptional experience. To give feedbackplease email us at support@reqroute.com.
💡 Quick Summary
Seeking a career-building opportunity? The Remote Facets Claim Processor position is now open for candidates interested in the Work from home Jobs sector. This role in Addison offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.