Claim Adjudicator III

at Evolent Health

Louisville, KY

Posted on May. 15, 2017

Full Time

It’s Time For A Change…Your Future Evolves Here

DON'T MISS THE OPPORTUNITY TO MEET WITH OUR HIRING MANAGERS IN PERSON WEDNESDAY MAY 24TH. ANYTIME BETWEEN 10AM - 2PM.

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—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. 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:
We are looking for an experienced individual to fill our Claims Adjudicator III team position. The successful candidate will have at minimum 5 years of experience adjudicating claims in a Claims Center environment. They will use their proven strong analytical skills to review claim rules and workflows. Additional essential functions would also be:

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, DRG and Rev Codes, etc.)
Research CMS1500 claim edits to determine appropriate benefit application utilizing established criteria
Multiple surgery claim review
Apply physician contract pricing as needed
Facility claim adjudication including coding, reimbursement methodologies and benefit level applications
Apply hospital contract pricing as needed
Ability to resolve claims that require adjustments and adjustment projects
Resolve member/provider inquiries
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

The Experience You’ll Need (Required):
Associate or Bachelor degree preferred.
Proficient experience in health insurance claims processing with a minimum of 5+ years adjudication experience.
HMO Claims or managed care environment preferred.
Ability to work in a team environment
Integrity and discretion to maintain confidentiality of members, employee and physician data
Proficient knowledge of medical billing and coding
Proficient knowledge of health insurance, HMO and managed care principles
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
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Able to work independently; strong analytic skills
Strong computer skills
Evolent Health is an Equal Opportunity/Affirmative Action Employer

TO APPLY:
DON'T MISS THE OPPORTUNITY TO MEET WITH OUR HIRING MANAGERS IN PERSON
10am - 2pm. Make sure to dress professional and bring several copies of your resume.

To access the Job Fair Address:
1. Fill out the quick apply form and select "Apply Now".
2. Then select employer address to access the Job Fair location and address.

Evolent Health is an Equal Opportunity/Affirmative Action Employer

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