The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Investigate claim inquiries/ rosters containing claims related data while utilizing various systems and analytical skills in order to research claims denials/ perceived inappropriate payment or any other claims-related concerns and inquiries; Maintain resolution roster as adherent to the claims Resolution Unit's policies, procedures and workflows. Remain compliant with the CRU established timeframes. Communicates the investigation results to the provider/ designee and advise on the steps for the plan of correction. Facilitate collaboration with various departments while working on claims resolution. Meet with the Claims Department designee, weekly, to establish estimate completion dates pertaining to the claim rosters. Properly handle all incoming inquiries while creating new system inquiries for reporting purposes.
We truly value our staff and further acknowledge their contributions by offering: