Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $19.32 - $24.13 Scheduled Weekly Hours: 40 Position Overview ESSENTIAL FUNCTIONS Processes medical invoices, check requests and expense reports in accordance with established procedures which includes: reviewing invoices for accuracy; code expenses, photocopies invoices and files copies, sends original documents to Accounts Payable for payment; maintain vendor and participant files; work effectively with vendors and colleagues in a customer service-oriented manner; and track unpaid invoices Utilizes EMR as appropriate to obtain authorization information. Creates files, inputs and maintains data in Excel spreadsheets, and generate reports as needed. Works closely with all departments to ensure all authorizations have been added for claims received. Generates authorization file weekly in EMR and send to TPA. Reviews the weekly Pre-check Register for accuracy ensuring there is an authorization, a claim and supporting documentation prior to approving payment. Reviews the weekly Pend Report for approval and follows up with appropriate department for those claims missing authorizations and/or documentation. Works closely with in-house adjudication department in all aspects of claim processing. Follows up with outside providers if necessary. Answers phone and responds to questions from participants, family members and co-workers. Manages claims denials and resubmissions. Tracks and enrolls participants in Medicare and supports Medicaid enrollment and approval process. Performs other duties as assigned.
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Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED