Claims Resolution Representative 1

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Claim Resolution Representative

• Are you an experienced Claim Resolution Representative looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

If so, you might be our next new team member!

Who we need:

The Adjustment & Resolutions Representative will assist with bill-specific research to resolve outstanding issues and provide guidance in a variety of duties. In addition, will assist with the management of departmental inventory, identifying trends, and work assignments for staff. This position is located in Cheyenne, Wyoming.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide you additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

• Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments.
• Determine when to use a "Forcible" disposition to override the edit and process the claim based on operational claims adjudication procedure.
• Available to work from 7:00 AM to 6:00 PM Mountain Time on all State business days, Monday through Friday (excluding Wyoming State holidays).
• Review and analyze claims and follow up on the status of claims and reimbursement.
• Identify areas for provider education to promote provider claims correction on their first response and communicate these to management and Field Representatives.
• Eliminate the back and forth with the Provider when correcting a claim.
• Interpret and apply policy and reimbursement rules to support provider inquiries.
• Ensure accuracy and consistency of claims processing.
• Fix errors or inconsistencies as they are identified and notify staff member(s), when applicable, and re-train or corrective action as required.
• Train on operational procedures and review operational procedures and standard management practice.
• Independently research and resolve medical bill data, making necessary corrections of information by comparing data with source documents to identify root causes.
• Request additional information needed to complete the adjudication of bills.
• Research and review submitted bills (paper or electronic) requesting adjustment consideration, and process according to Wyoming Department of Health policies and procedures.
• Make the appropriate bill adjustment into the claims system according to contractual requirements and timelines.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Job Qualifications

What you’ll need:

Required Qualifications

• High School diploma or GED.
• Able to follow written guidelines and procedures

Knowledge, Skills, Abilities

• Have the ability to simultaneously maneuver through various computer claims and eligibility platforms.
• Outstanding customer satisfaction skills.
• Must have the ability to be firm but professional with contacts while performing tasks.
• Must have friendly personality, tact, patience, empathy, and a helpful yet professional attitude.
• Knowledge of claims review and analysis
• Strong computer skills (MS Word and Excel).
• Excellent oral and written communication skills.
• Excellent organization a