Fund Control Specialist
Wellpath•Franklin, TN
1d
About The Position
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.
Benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
