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Company Name : Rocky Mountain Health Care Services
Location : Colorado Springs, CO 80909
Position : Medical Claims Processor
Job Description : Have you always wanted to work for a GREAT company? If so, then Rocky Mountain Healthcare Services might be the right place for you!RMHCS won 3rd place in the Colorado Springs Business Journal’s Best in Business and was a finalist in the Gazette Best Place to Work, both in 2020 and we have a skilled Medical Claims Processor* opportunity at Rocky Mountain PACE (Program for All-Inclusive Care for the Elderly) in the heart of Colorado Springs, Colorado.*The mission at Rocky Mountain Health Care Services is improving lives, optimizing wellness, and promoting independence. We work diligently to keep individuals as highly independent as possible. We deliver exceptional care to enrich the lives of our participants and empower them to live vibrant, independent lives.Older adults have unique, ever-changing needs. PACE—Program of All-inclusive Care for the Elderly—enriches the lives of older adults because of the comprehensive, integrated services we provide. Our goal is to help older adults maintain the highest level of independence possible.Rocky Mountain PACE is the only national PACE program in the Pikes Peak region, offering a holistic suite of services to meet the health care needs of older adults in our community. Older adults and their families do well if they have a role in their own health and we see ourselves as partners in their well-being. From their physical, social, and emotional health, to the simple things like transportation and supportive services that help them access their care, we partner with older adults in keeping them as independent as possible.Medical Claims Processors are responsible for processing, adjudicating, and paying all PACE program participant medical insurance claims including performing the daily customer service activities surrounding the claims process.Processes provider claims including validation, coding, data entry, adjudication, and importing/exporting in claims management systems. The standard rate of processing claims is 20 1500’s and 8 UB’s per day and prior month’s claims are to be entered and adjudicated by the second business day of the month.Prepares and disburses payment checks with explanation of payments (EOPs) to providers.Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolutionActs as the primary contact for support and resolution with internal departments, program participants as well as external provider representatives for questions about claim status, appeals, etc.Assists with research, development, implementation, and documentation of processes including identifying process gaps or issues along with appropriate solutions and inputs those processes into the departmental book of business as requested.Other duties as assigned.High school diploma or equivalent required.Minimum 3 years health insurance claims processing required. Working knowledge of Medicare/Medicaid 1500 and UB claims preferred.Accounts payable experience highly desirable.Strong written and verbal communication skills.Location: 2502 E Pikes Peak Avenue Suite 100, Colorado Springs, CO 80909Job Type: Full-timePay: $19.89 – $24.31 per hour
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