Remote Facets Claim Processor

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)

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