Easter Seals Jobs

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

Reporting to the Supervisor - Provider Disputes, this position is responsible for the review of provider disputes submitted by providers, the analysis of claims and disputes to determine ownership for resolution and the review of disputes versus member appeals for timely reassignment to appropriate stakeholders.; Responsibilities are but not limited to;

• Performs administrative tasks, included but not limited to, Fax Management (storage and distribution), letter processing and storage, data collection and assembling/filing completed disputes within provider disputes platform.

• Manages, adjudicates, and determines ownership of provider disputes submitted from providers, account executives and PCSU. Investigates findings of claim denials and reports ;underlying reasons for identified data quality issues to management.

• Participates in quarterly meeting with governing body and reports comprehensive list of data quality issues present during a given period.

• Communicates with providers to resolve problems with provider dispute requests that are not submitted according to Plan’s policy.

• Maintains an accurate, timely and complete record of provider disputes in a system that tracks the stages of the dispute, how long it takes to resolve the disputes, and manages distribution of the provider disputes to the appropriate stakeholders.

• Adheres to timely resolution of dispute process as established in current Plan’s policy.

• Collects, analyzes and reviews historical provider dispute information to incorporate into departmental provider dispute documentation.

• Ensures compliance with record retention plan according to Plan’s policy.

• Coordinates the presentation of the provider disputes to a Provider Disputes Team Lead, Supervisor or manager and participates as a member for a 2nd review.

• Communicates decisions (either verbally or in writing) made by the Provider Dispute team to providers within Plan timeframe, when necessary.

• Identifies and reports on provider issues appropriate for use as educational opportunities to the Provider Services management staff.

• Other duties as assigned by management.

Education/ Experience:

• High School Diploma/GED required.

• Associate Degree with an emphasis in health services administration or equivalent experience and education preferred.

• Medical office admin and/or claims admin, especially Medicaid billing preferred.;

• 1 to 3 years medical office billing experience.

Other Skills:;

• Proficiency in MS Word, Excel & PowerPoint.

• 100% Remote position and you can live anywhere in South Carolina.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.