Fund Control Specialist

Wellpath•Franklin, TN

About The Position

Fund Control Specialist You Matter Make a difference every day in the lives of the underserved Join a mission driven organization with a people first culture Excellent career growth opportunities Join us and find a career that supports: Caring for overlooked, underserved, and vulnerable patients Diversity, equity, inclusion, and belonging Autonomy in a warm team environment Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: DailyPay, receive your money as you earn it! Tuition Assistance and dependent Scholarships Employee Assistance Program (EAP) including free counseling and health coaching Company paid life insurance Tax free Health Spending Accounts (HSA) Wellness program featuring fitness memberships and product discounts Preferred banking partnership and discounted rates for home and auto loans Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference The Fund Control Specialist performs pre- and post-payment audits of external claims; ensures that the company rigorously manages claims for external services; ensures that claims are paid according to contracted rates, for approved services, and are otherwise appropriate and correct; reviews and responds to claims submitted on appeal.

Requirements

Bachelor’s degree or equivalent experience.
Minimum of five years of experience in claims processing and claims audit functions.

Responsibilities

Complete accurate and timely audits of out-of-facility claims, confirming eligibility, claim amounts, and related events.
Maintain financial and administrative controls to support proper claim payments while ensuring compliance with standards, audit criteria, contracts, and policies.
Perform claims appeals and high-dollar reviews, including contract compliance checks and written responses.
Review and validate the use of current provider contracts, fee tables, reference data, and contract batches, and provide quality assurance before submission.
Track and report audit findings, identify issues and solutions, oversee the FBOP inbox, and provide estimated procedure costs when requested.