Job title: Claims Adjudicator III
Company: Evolent Health Services
Job description: It’s Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We
It’s Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized Definitely. We have been named one of ‘Becker’s 150 Great Places to Work in Healthcare’ in 2016, 2017, 2018 and 2019, and one of the ’50 Great Places to Work’ in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it. What You’ll Be Doing: Position Summary: Proficient level adjudicator providing strong analytical skills to Review and finalize intermediate-level as well as most complex claims, including but not limited to inpatient and outpatient facility claims, multiple and bilateral surgical claims, complex anesthesia claims, other professional claims, preauthorization requirements, high dollar claims, DME, third-party liability and coordination of benefits. Roles & Responsibilities: Experienced level adjudicator providing analytical ability to review claim rules and workflows Conduct professional communication and interaction with clients as needed. Assist and present knowledge share information with team members as needed. Responsible for adjudicating claims to maintain/comply with Service Level Agreements Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures Ability to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.) Research CMS1500 claim edits to determine appropriate benefit application utilizing established criteria, Apply physician contract pricing as needed. Ability to resolve claims that require adjustments and adjustment projects Identify claim(s) with inaccurate data or claims that require review by appropriate team members Maintain productivity goals, quality standards and aging timeframes Contribute positively as a team player Complete special projects as assigned Comply with all departmental and company Policy and Procedures Mandatory Skills : Associate or Bachelor degree preferred or further education. Experience in health insurance claims processing with a minimum of 0 to 9 years adjudication experience. Preferred skills : Ability to work in a team environment Integrity and discretion to maintain confidentiality of members, employee and physician data Knowledge of medical billing and coding Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products Able to work independently strong analytic skills Strong computer skills
Expected salary:
Location: Pune, Maharashtra
Job date: Sat, 26 Mar 2022 23:48:48 GMT
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