Claims & Adjustment Specialist

Colorado Access•Denver, CO

4d•$65,900 - $77,700•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. We are looking for a CLAIMS & ADJUSTMENT SPECIALIST who can help shape our vision and support our mission. Here is what the position will look like.

Requirements

Education: High School Diploma or equivalent required. 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.
Experience: Minimum of four years’ healthcare experience. Three years of claims or appeals processing experience preferred.
Knowledge, Skills, and Abilities: 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. Knowledge of Microsoft Excel, Access & Word strongly preferred. May be required to manage multiple priorities and projects with tight deadlines.
Licenses/Certifications: 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.
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 as established by department director.
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

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).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).