Claims Processor II

🔥 0 minutes ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

InnovAge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

InnovAge is a provider of the Program of All-inclusive Care for the Elderly (PACE) that helps frail seniors remain independent and age in their own homes with dignity. As the largest PACE provider by participants served, InnovAge delivers comprehensive, coordinated services including primary care, nursing, behavioral health, therapies, transportation and care coordination to support seniors' medical and daily living needs.

📋 Description

• Accurately and timely process UB, HCFA, and Dental claims submitted by external providers according to company and CMS guidelines • Monitor and process claim audits to maximize accuracy and minimize expense • Interact with external providers, vendors, and agencies regarding claim submission, processing, and payment • Train providers and address provider appeals according to CMS and NCCI guidelines • Research and clear pended and rejected claims through system updates and corrections • Downgrade DRG claims and reprocess them as directed by the external audit vendor • Process provider refunds and reconcile related activity with Accounts Payable • Answer inbound customer service calls and emails regarding claim status, eligibility, benefits, billing, and payment • Pull daily reports and resolve issues preventing claims from processing, including loading provider data to the PCM claims system • Conduct weekly batch reviews and monitor internal reports to maximize payment accuracy • Load new providers to InnovAge’s PCM Network under team lead supervision • Coordinate approval of non-contracted provider claims with Center Leadership • Research and resolve provider billing and payment reconciliations • Maintain provider fee schedules for Housing providers • Train external providers on CMS UB04, HCFA, and Dental claim submission • Process refunded payments back to the claims system and maintain reconciliation spreadsheets • Work weekly Virtual Examiner audits and Varis IP audits, adjusting claims and submitting invoices to AP • Review and respond to provider appeals, including claim research, adjustment, and drafting responses • Resolve claims issues through contact with participants, physicians, facilities, and others • Hand-key paper claims activity loaded in KL and process Smart Data rejects

🎯 Requirements

• 3+ years as a Claims Processor or in a similar role in a doctor’s office, healthcare clinic, or other healthcare setting, or equivalent combination of education and experience • Ability to type 10,000+ KSPH alpha/numeric • Ability to produce business correspondence for participants and regulatory agencies • Intermediate customer service skills • Ability to research and communicate information to callers in a timely manner • Experience with copiers, scanners, and multi-line phone systems • Current experience communicating claims issues with physicians and their staff, participants, and regulatory agencies • Associate degree or Certificate in healthcare sciences, health information technology, or a related field from an accredited college • Experience with medical billing and/or coding preferred • Experience with document imaging systems and Medical Terminology preferred • Prior experience with Plexis, Virtual Examiner, ABCT, and Encoder Plus preferred • Prior audit experience preferred • Bi-lingual in Spanish preferred

🏖️ Benefits

• Medical, dental, and vision insurance • Short- and long-term disability insurance • Life insurance and AD&D • Supplemental life insurance • Flexible spending accounts • 401(k) savings plan with company match • Paid time off • Company-paid holidays • Equal opportunity and affirmative action workplace • Diverse and inclusive workplace • Patient-centered care model • Work alongside talented, respectful, and passionate colleagues