Resolution & Adjustment Coordinator-SCA

Acentra Health, LLC•Tallahassee, FL

1d•$21 - $26•Hybrid

About The Position

Acentra Health is looking for a Resolution and Adjustment Specialist (SCA) to join our growing team. The Resolution and Adjustment Specialist conducts bill-specific research and adjudicates claims accurately and promptly in accordance with OWCP policies. This position will require work to be performed on-site in Talahassee, FL one week a month, no exceptions.

Requirements

Hybrid work - one week a month on-site
Possess a high school diploma or GED
3+ years of experience conducting research to resolve medical billing issues.
Demonstrated knowledge of medical terminology, including diagnosis and procedure codes
Familiarity with medical billing and claim forms, along with common coding schemes (certification preferred)
Ability to efficiently navigate and operate multiple computer claims systems and software platforms simultaneously

Nice To Haves

Knowledge of claims review and analysis
Strong computer skills (MS Word and Excel)
Excellent oral/written communication and organizational skills
Ability to prioritize and manage time effectively

Responsibilities

Independently resolve suspended claims using the resolution screens in accordance with operational procedures
Apply a “Forcible” disposition when appropriate to override edits and process claims per established guidelines
Review and analyze claims independently to ensure accuracy and completeness
Maintain accuracy and consistency throughout the claims‑processing workflow
Train on and adhere to operational procedures and standard management practices
Research and resolve medical bill data issues by comparing information with source documents to identify root causes
Review and process paper and electronic bills submitted for adjustment in accordance with OWCP policies and procedures
Review and process suspended claims and all related documentation
Facilitate manual entry of claims into the system as needed
Perform manual reviews on claims, documents, and attachments to ensure compliance and accuracy
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules