Claims (Medicaid) Eligibility Specialist - Local to Robbinsville, New Jersey

Amerihealth Caritas Health Plan - Robbinsville, NJ

Full-time - Entry Level

Hybrid - Robbinsville, NJ

Insurance Carriers and Related Activities

About the position

The Claims Eligibility Specialist is the point of contact for the Provider community to resolve issues related to Medicaid coverage and services. The incumbent coordinates and collaborates with internal associates and staff from various Provider agencies on Medicaid eligibility and claims issues. In addition to resolving discrepancies in coverage, eligibility, enrollment, and billing, the Claims Eligibility Specialist reviews, researches, and investigates claims and authorization data to support the analysis and identification of trends.

Responsibilities

• Serve as the point of contact for the Provider community regarding Medicaid coverage and services.
• Coordinate and collaborate with internal associates and staff from various Provider agencies on Medicaid eligibility and claims issues.
• Resolve discrepancies in coverage, eligibility, enrollment, and billing.
• Review, research, and investigate claims and authorization data.
• Support the analysis and identification of trends related to claims and eligibility.

Requirements

• High School Diploma or equivalent required.
• Minimum one (1) year of experience in Medicaid Claims and Billing Process.
• Current/recent in-depth knowledge of coverage and services offered under the Behavioral Health Medicaid Program regarding authorizations, claims, billing, enrollment, and eligibility.
• Customer service experience required, preferably in a healthcare setting.
• Experience working in Microsoft Office (Excel, Word, and Outlook).
• Strong attention to detail.
• Ability to quickly and successfully embrace change and adapt effectively in response.
• Effective communication (listening, verbal, and written) and critical thinking skills.

Nice-to-haves

• Experience working with an Electronic Medical Record (EMR) preferred.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid Time Off (PTO), including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.