DesMoinesRecruiter Since 2001
the smart solution for Des Moines jobs

Claims Liaison I

Company: iowa total care
Location: Des Moines
Posted on: November 11, 2019

Job Description:

Job ID 1165113 Category Claims Operations Schedule Full-time Description: Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers’ claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc. Run claims reports regularly through provider information systems Research verbal and written providers’ claims inquiries as needed For PA H&W only: Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems. Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices Qualifications: Education/Experience: High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred. For PA H&W only: Must perform work within the state of Pennsylvania Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: iowa total care, Des Moines , Claims Liaison I, Other , Des Moines, Iowa

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Travel Physical Therapist - $1,800 per week
Description: NurseFly Travel Nursing with Alliance Allied Medical Staffing is seeking a travel physical therapist for a travel job in Des Moines, Iowa:
Company: TherapyFly Travel Therapy
Location: Des Moines
Posted on: 11/14/2019

Delivery Driver (part or full time) with DoorDash - Make up to $18/hour
Description: No passengers. No bosses. Just you, your tunes, and the road. Sign up now and start making money Choose your wheels and deliver food and other items from local merchants to
Company: Doordash
Location: Des Moines
Posted on: 11/14/2019

Driver - Dedicated Tanker Truck Driver - Bayer - Class A CDL
Description: This Dedicated Tanker truck driver position features an earning potential up to 73,000 per year with accessorial pay, weekly time at home and a predictable schedule. Dedicated Tanker drivers will haul (more...)
Company: Schneider National
Location: Des Moines
Posted on: 11/14/2019


Service Advisor - Paid time off - Des Moines
Description: The Service Department is an integral part of this Company s success. The Service Advisor is the link between the customer and the Service Department. The Service Advisor is responsible for accurately (more...)
Company: Midwest Peterbilt Group/SCTS Inc
Location: Des Moines
Posted on: 11/14/2019

RN Surgery- Cardiothoracic/Peripheral Vascular Surgery (Day/Evenings)
Description: Position Type: Regular br br Scheduled Hours per 2 week Pay Period: 80 br br Primary Location: IA DES MOINES MERCY MEDICAL CENTER br br GENERAL SUMMARY: br br Provides perioperative (more...)
Company: Mercy Medical Center
Location: Des Moines
Posted on: 11/14/2019

Driver - Dedicated Team Truck Driver - Class A CDL
Description: This Dedicated Team truck driver position earns up to 0.49 per mile with a weekly performance pay up to 0.04 per mile and offers home time every three weeks. Dedicated truckers will haul multi-stop, (more...)
Company: Schneider National
Location: Des Moines
Posted on: 11/14/2019

CMA - Des Moines Internal Medicine Clinic
Description: Position Type: Regular Scheduled Hours per 2 week Pay Period: 80 Primary Location: IA gt DES MOINES gt MERCY MEDICAL CENTER In healthcare, we all agree that support is a must
Company: Mercy Medical Center
Location: Des Moines
Posted on: 11/14/2019

Radiologic Technologist - South Des Moines Family Medicine & Urgent Care - PT 0.5
Description: Position Type: Regular br br Scheduled Hours per 2 week Pay Period: 40 br br Primary Location: IA DES MOINES MERCY SOUTH CLINIC br br GENERAL SUMMARY: br br Provides radiology services (more...)
Company: Mercy Medical Center
Location: Des Moines
Posted on: 11/14/2019

CDL-A DEDICATED COMPANY TRUCK DRIVERS & LEASE PURCHASE OPPORTUNITIES
Description: CDL-A DEDICATED COMPANY TRUCK DRIVERS amp LEASE PURCHASE OPPORTUNITIES 80 OF OUR DRIVERS ARE SEATED IN 3 DAYS Don't Wait, Call Now 423-445-7203 Choose U.S. Xpress for an EXTRA 12,000 in Your (more...)
Company: U.S. Xpress
Location: Des Moines
Posted on: 11/14/2019

DoorDash Delivery Driver - No Experience Needed
Description: No passengers. No bosses. Just you, your tunes, and the road. Sign up now and start making money Choose your wheels and deliver food and other items from local merchants to
Company: Doordash
Location: Des Moines
Posted on: 11/14/2019

Log In or Create An Account

Get the latest Iowa jobs by following @recnetIA on Twitter!

Des Moines RSS job feeds