Job Summary: Responsible for accurate and timely processing of claims.
Essential Functions:
Accurately process medical, facility and/or dental claims for Medicaid and Medicare members.
Research and process COB (Coordination of Benefit) claims.
Meet production and quality goals for claim processing and payment.
Perform claim adjustments and recoveries.
Process and respond to provider inquiry intakes from the Service Center.
Perform any other job related instructions as requested, with reasonable accommodation.
Position Requirements
Minimum Qualifications:Education:
High School Diploma or Equivalent
Experience:
One to three years' of previous claims experience
Technical Skills:
Basic computer skills with Excel and Outlook
Intermediate level experience performing data entry functions.
Knowledge & Skills
Medical terminology; CPT-4 and ICD-9 coding strongly preferred
Ability to work independently and within a team
Attention to detail
Time management skills
Decision-making and problem solving skills
Communication skills
Research skills
Knowledge of billing practices
Educational Requirements
High School diploma or equivalent
License Requirements
none
Full-Time/Part-Time
Full-Time
Shift
Days
Salary
About the Organization
CareSource is the 2nd largest Medicaid managed health care plan in the country, and our strength lies in our experience. CareSource provides a full spectrum of services for the administration of public-sector health care programs, serving more than 900,000 Medicaid consumers in Ohio and Michigan.
Our health plans are founded on the principles of quality and service delivered with compassion and a thorough understanding of Medicaid, Medicare, and the associated regulatory environments. We offer a unique approach to managed care through the process efficiencies and value-added benefits we offer to our members and the health care providers we partner with to serve them. As a managed health care organization, CareSource focuses on prevention with a goal of improving member health and the quality and accessibility of health care services for Medicaid consumers. CareSource assists in the coordination of member care by partnering with a defined network of participating doctors, hospitals and other health care providers.
CareSource Benefits
CareSource is an equal opportunity employer that offers a drug and tobacco free environment and a competitive compensation and benefits package to full-time and part-time employees who work at least 24 hours per week.
The benefits package includes:
Health, dental and vision insurance
Flexible spending accounts (health and dependent care)
Life insurance
Accidental death and dismemberment insurance
Short- and long-term disability insurance
401(k) retirement plan
Liberal paid personal time to be used on a discretionary basis for sick leave or as scheduled time off
Eight paid holidays and a floating holiday
Educational reimbursement
For more information about CareSource, please see About Us on our website, www.caresource.com.
CareSource - 9 months ago
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