Navitus Health Solutions · 6 hours ago

Coordinator I, Recoveries

United States

Full-time

Remote

Entry Level

$20.44/hr - $24.33/hr

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Responsibilities

Is responsible for successfully processing claims within the claims adjudication system for specified client performance guarantee timeframes, guarding client and Navitus from potentially high dollar financial liabilities

Collaborates with requester insuring all appropriate information is received to process the request

Creates, validates, and confirms large batch of claims prior to electronically processing

Learn and abide by regulatory requirements to participate in Client, State, and Federal Audits which includes compilation of claim files, audit universes, report creation and analysis, validation of claim against benefit allowances, and responding to auditor questions verbally and in writing

Assist in review and audit the outcome of the processed claim

Assist in creating and maintaining internal team documentation and training materials

Participates in process re-design of team initiatives

Participates with communicating to all departments the nature of processing claims; providing talking points for Member Services to explain claim processing reimbursements to members and pharmacies, and Client Services or Government Programs to explain claim correction outcomes

Runs necessary reports to analyze overall impact of request

Other duties as assigned

Qualification

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Claims processingPBM knowledgeManaged care knowledgeRegulatory compliance