Adjudicator, Provider Claims-On The Phone-Ohio

Molina Healthcare • Macon, GA • 3h ago

Job Description

Job Summary

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems.

Knowledge/Skills/Abilities

Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems.

This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing.

Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions.

Assists in the reviews of state or federal complaints related to claims.

Supports the other team members with several internal departments to determine appropriate resolution of issues.

Researches tracers, adjustments, and re-submissions of claims.

Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards.

Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management.

Handles special projects as assigned.

Other duties as assigned.

Knowledgeable in systems utilized:

QNXT

Pega

Verint

Kronos

Microsoft Teams

Video Conferencing

Others as required by line of business or state

Job Function

Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators.

Job Qualifications

REQUIRED EDUCATION:

Associate's Degree or equivalent combination of education and experience;

REQUIRED EXPERIENCE:

2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems.

1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry

PREFERRED EDUCATION:

Bachelor's Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

4 years

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $21.16 - $38.37 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Finance Analyst - Power Market

Kiewit • Juliette, GA • 1d ago

Finance, Accounting & Banking

Requisition ID: 177330 Job Level: Entry Level Home District/Group: Power Market Department: Operational Finance Market: Power Employment Type: Full Time Position Overview Are you interested in helping be responsible for...

1d ago

Go to Apply

Adjuster, Claims (Remote)

Molina Healthcare • Macon, GA • 1w ago

Finance, Accounting & Banking

JOB DESCRIPTION Job Summary Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage amount and benefit interpretation. Monitors and controls backlog...

1w ago

Go to Apply

Adjudicator, Provider Claims (LTSS Call Center)

Molina Healthcare • Macon, GA • 1w ago

Finance, Accounting & Banking

Job Description Job Summary The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. Th...

1w ago

Go to Apply

Advisor Development Program - Financial Solutions Advisor Trainee (Centralized) - Macon, GA Merrill Office

Bank of America • Macon, GA • 2w ago

Finance, Accounting & Banking

Advisor Development Program - Financial Solutions Advisor Trainee (Centralized) - Macon, GA Merrill Office Macon, Georgia To proceed with your application, you must be at least 18 years of age. Acknowledge Refer a friend...

2w ago

Go to Apply

Finance Manager - REMOTE

Molina Healthcare • Macon, GA • 3w ago

Finance, Accounting & Banking

JOB DESCRIPTION Job Summary Responsible for analysis of financial reports, trend, and opportunities. Includes evaluation of and recommendations relating to business opportunities, investments, financial regulations, and...

3w ago

Go to Apply

Retail Stocking Supervisor

Harbor Freight Tools • Warner Robins, GA • 13h ago

Retail & Hospitality

168545BRPosting Title:Retail Stocking SupervisorJob Description: A Supervisor (full-time) is a valued member of a high performing team who is empowered & equipped to do their job. You will know why your work matters...

13h ago

Go to Apply

Physical Therapy Assistant (PTA) - Full-Time / $5,000 Sign-On Bonus

Select Medical • Macon, GA • 1d ago

Hospital & Medical

Overview Position: Physical Therapy Assistant (PTA) Location: Macon, GA Schedule: Full-Time Sign-On Bonus: $5,000 Regency Hospital - Macon is a critical illness recovery hospital committed to providing world-class inpati...

1d ago

Go to Apply

AVP, Medicare Duals Optimization (REMOTE)

Molina Healthcare • Macon, GA • 1d ago

Job Description Job Summary Provides leadership to a team that is responsible for strategy, process improvements, and operational support to advance the goals and objectives of the Integrated Duals program. Supports inte...

1d ago

Go to Apply

Field Service Technician

Tanknology • Forsyth, GA • 3d ago

Management & Administrative

3d ago

Go to Apply

Speech Therapist

PruittHealth • Forsyth, GA • 3d ago

Hospital & Medical

SPEECH LANGUAGE PATHOLOGIST (SLP) -PRN THERAPY SERVICES Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the heal...

3d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.