PA Health & Wellness ยท 16 hours ago
Claims Research Specialist
Pennsylvania, United States
Full-time
Hybrid
Mid Level
$23.23/hr - $39.61/hr
3+ years expCentene is transforming the health of our communities, one person at a time. The Claims Research Specialist will act as a liaison to investigate and resolve claims inquiries, ensuring data integrity and assisting providers with claims submission issues.
FitnessHealth CareWellness
No H1B
Responsibilities
Perform duties to act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries
Receive and respond to internal and external claims related issues
Initiate entry or change of provider related database information
Complete claims related research projects
Assist with responsibilities related to data integrity of provider claims processing system
Investigate and communicate reimbursement and benefit changes
Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission
Assist providers with resolving issues with claims submission and payment accuracy
Attend state meetings with regards to fee schedule and benefit changes
Assist with provider complaints & resolutions regarding claims issues and process claims adjustments
Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system
Qualification
Required
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
High school diploma or equivalent
3+ years of experience in claims payment processing in government programs
Experience in a managed care environment
Knowledge of claims billing and processing functions
Knowledge of Medicaid benefits
Customer service experience
Preferred
Bachelor's degree
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
PA Health & Wellness
Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Justin Davis
President and Chief Executive Officer
Recent News
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