Adjudication Representative 8/17/2016
JOB DESCRIPTIONAPPLY Requirements:
-Qualified candidates must have a High School diploma or have a General Education Degree (GED)
- Prior insurance or billing experience in medical environment preferred
- Prior book-keeping experience or claims processing experience preferred
- Prior customer service experience preferred
- Prior collections experience preferred
- Experience using internet search tools and Microsoft Office
- Excellent oral and written communication skills
- Communication, Oral - Ability to communicate effectively with others using the spoken word
- Interpersonal - Ability to get along well with a variety of personalities and individuals
- Detail Oriented - Ability to pay attention to the minute details of a project or task
- Organized - Possessing the trait of being organized or following a systematic method of performing a task
- Time Management - Ability to utilize the available time to organize and complete work within given deadlines
Environmental and Working Conditions:
-Entire work time is conducted in an office setting.
Physical and Mental Requirements:
-Ability to work independently or with a team a must
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare's client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.
We have full time openings for Adjudication Representatives to base at our new Claims center located in Phoenix, AZ. The Adjudication Representative is responsible for pre-billing, patient account billing, and patient account collections. This job involves heavy computer use and public telephone contact.
Essential Duties & Responsibilities:
- Determine if claim should be billed to 3rd party payer or as a private pay
- Verify eligibility and covered benefits with insurers for all provider claims for non-contracted transports or for contracted transports not verified by the Phoenix Call Center
- Identify provider claims that should be questioned for Coordination of Benefits
- Check accuracy of charges submitted for payment including fee schedule type, diagnosis, mileage, supplies and appropriate level of service
- Obtain billing authorizations, when required, for all non-contracted transports or contracted transports not previously obtained from the Arizona Call Center
- Enter claims into Logisticad (Logisticare s proprietary software) that fall outside of the normal process
- Obtain correct billing address information
- Determine potential MRU claims
- Other duties as assigned
Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.
LogistiCare is an Equal Opportunity Employer.