Claims Processor

WHO WE ARE

iCare Health Options offers a full continuum of healthcare third party administrative services such as:  network management, claims processing, credentialing, utilization management, HEDIS outreach programs and much more. We have over 30 years of successful operating experience in partnering with managed care companies to administer health benefits such as ophthalmic, optometric, podiatric and medical transportation for major health plans.

Due to our dedication and investment in technology we are able to offer our network providers innovative technology based-tools, enabling them to focus on quality care. In turn, our network provider’s time is spent focusing on patients care and not on paperwork.

Please see our website for more information:  www.icarehealthoptionstpa.org

 

JOB DESCRIPTION

We are seeking a Medical Claims Processor to join our team. The candidate will play an active role within our Claims Operations to assure timely and accurate administration of claims processing, in compliance with state and federal regulations, as well as other applicable rules and requirements outlined by internal and external policies and procedures.

 

Responsibilities:

  • Review claims and corresponding edits to determine the appropriate handling of payments and denials
  • Review formal written appeals from providers, and send written responses of decisions within required timelines
  • Investigate claims issues by performing research and gathering information to determine the root cause of the problem
  • Communicate and collaborate with impacted departments to resolve claims issues
  • Perform other duties assigned by supervisor, and assist on requests from Compliance Department as needed
  • Address inquiries from providers
  • Maintain a full comprehensive understanding of claims policies and procedures by studying appropriate reference materials including covered benefits, coding and reimbursement policies and contracts; participate in ongoing training as needed

 

 QUALIFICATIONS

Required Qualifications:

  • High school diploma, GED or equivalent required
  • At least three years of health care administration and/or managed care experience
  • At least three years of claims experience that demonstrates progressive growth within claims operations
  • Strong understanding of health plan terminology
  • Computer literate and proficiency in Microsoft Office

 

Preferred Qualifications: 

  • Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits.

 

BENEFITS

At iCare Health Options we are a dedicated family of professionals with a strong desire to deliver quality services to our clients and their customers. We promote from within and offer internal advancement opportunities. For this role, we offer a competitive pay rate and benefits package. We provide the resources, training and support you need to be successful! Our associates enjoy a fun and team oriented environment.
Other benefits of the role include:

  • Paid Time off program
  • Paid Holidays

Voluntary Benefits

  • 401(k) Retirement Plan with Company Match
  • Healthcare Insurance
  • Medical and Dental Insurance
  • Life Insurance

Location: Doral, FL
Schedule: Monday – Friday; 8:15 am-5:00 pm

 

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