Job Discription
Resolve Claims: Review batch claims assigned on a daily basis that are in an Error, Pended or Payable status. Resolution may include but is not limited to pricing, assigning benefits, selecting patient, selecting provider, clearing and/or adding specific error, pend or payment Explanation of Payment codes, etc.
Process Claims: Apply plan provisions to medical and behavioral health claims in batch according to Medicaid and/or Medicare requirements, CT billing standards and current claim policies and procedures. Coordinate benefits with primary insurance as applicable. Meet internal and client quality and turn-around time requirements.
Production and Quality: Claims turn-around time from receipt to paid as well as quality standards are contractually required by Trilogy and must be met. The volume of claim receipts varies day to day so production required to continually meet the requirements will vary respectively.
Related Activities: Claim adjustments, managing refund requests and receipts, assisting with recoup investigation, reviewing Customer Service requests for reconsideration, and other support role activities.
An Equal Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, or marital status, or the presence of a non-related medical condition or disability
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