Claims & Adjustment Specialist

Colorado Access•Denver, CO

6d•Hybrid

About The Position

Colorado Access is a Colorado-based company dedicated to improving the health of the state by serving individuals, families, and children who receive healthcare through Child Health Plan Plus (CHP+) and Health First Colorado. The organization focuses on enhancing quality, member experience, outcomes, and cost. It is a mission-driven organization with a vision, values, and a commitment to diversity, equity, and inclusion. This role offers work/life balance with benefits like PTO, floating holidays, company-paid holidays, a hybrid work environment, an Employee Assistance Program, and a 401K. The position is an opportunity to be part of a larger purpose, serving underserved and vulnerable populations through access to quality, affordable healthcare, thereby making a community impact. The company also supports professional development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

Requirements

High School Diploma or equivalent required.
Minimum of four years’ healthcare experience.
Solid knowledge of claims payment and record keeping required.
Must possess basic understanding of health care, medical terminology, medical procedures and managed care principles.
Requires familiarity with all claim forms and coding types including CPT/HCPCS, ICD-10, HCFA 1500 and UB-92.
Demonstrates support for the company’s mission, vision and values.
Excellent organization skills and decision-making skills required.
Excellent written and verbal communications skills required.
Must be able to interpret data and effectively summarize information.
May be required to manage multiple priorities and projects with tight deadlines.
A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Nice To Haves

Associates degree in health, social services or additional college courses preferred.
Equivalent combination of experience and/or education may substitute with a preference for four years progressive relevant work experience.
Three years of claims or appeals processing experience preferred.
Knowledge of Microsoft Excel, Access & Word strongly preferred.

Responsibilities

Researches, analyzes, and determines appropriate outcome for provider carrier disputes based on company policies and procedures and regulations, while meeting quality and production standards.
Documents and maintains claim appeal status in the claim appeal tracking tool.
Sends out applicable provider carrier dispute outcome letters, and other correspondence.
Performs research and analysis on a variety of claim adjustments.
Applies claims knowledge, company policies and procedures, and regulations to appropriately adjust claims.
Manages and works daily claim pend reports.
Finalizes claims as needed and communicates with Cognizant on the status of daily pend reports.
Submits, manages and follows up on Snow tickets associated with claims and appeals to Cognizant.
Assists with auditing of special projects, as needed.
Assists with department training of new employees.
Serves as a back up to the Claims Coordinator and will log in claim appeals into the claim appeals tracking tool, when needed.

Benefits

PTO
floating holidays
nine company paid holidays
hybrid work environment
Employee Assistance Program
401K
tuition reimbursement
leadership training
promotion opportunities
performance evaluations
employee recognition
language pay stipend
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Annual bonus program (based on eligibility, requirements and performance).