Acentra Health · 15 hours ago
Claims Resolution Representative
United States
Full-time
Remote
Entry Level
$18/hr - $23/hr
1+ years expAcentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Claims Resolution Representative to ensure accuracy in claims processing and serve as a liaison between members, providers, and the internal claims department.
Health Care
Responsibilities
Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments
Determine when to use a "Forcible" disposition to override the edit and process the claim based on operational claims adjudication procedure
Review and analyze claims and follow up on the status of claims and reimbursement
Interpret and apply policy and reimbursement rules to support provider inquiries
Ensure accuracy and consistency in claims processing
Research and review submitted claims (electronic) and process them according to policies and procedures
Possess an unwavering commitment to customer service and operational excellence
Perform manual pricing and audit checks to ensure compliance with policies and rules
Review and process suspended claims and submitted documentation
Provide sufficient detail to explain claims denial reasons
Implement workflow processes and capabilities for work queues with the ability to route workstreams
Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims
Perform manual reviews on claims, documents, and attachments
Release individual claims for providers on review
Independently resubmit claims with applicable corrections
Independently address discrepancies in charges, payments, adjustments, and demographic information
Facilitate manual entry of claims into the system
Review paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers
Other duties as assigned
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules
Qualification
Required
High School Diploma or GED
1+ years of experience conducting research to resolve issues within the healthcare field
Preferred
Ability to maneuver through various computer claims and eligibility platforms simultaneously
Outstanding customer satisfaction skills
Must be firm but professional when interacting with contacts while performing tasks
Friendly personality, tact, patience, empathy, and a helpful yet professional attitude are essential
Strong computer skills, including proficiency in MS Word and Excel
Excellent oral and written communication skills
Excellent organization and time management skills, with the ability to establish priorities effectively
Ability to read, write, and follow directions
Self-directed and capable of working without direct supervision
Ability to collaborate effectively with others
Create and maintain a positive atmosphere, demonstrating leadership qualities
Knowledgeable in claims review and analysis
Benefits
Comprehensive health plans
Paid time off
Retirement savings
Corporate wellness
Educational assistance
Corporate discounts
Company
Acentra Health
Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2022-11-09Acquired
Leadership Team
Todd Stottlemyer
Chief Executive Officer
Grant Christie
Senior Vice President, Market Strategy and Solutions
Recent News
2026-02-04
2026-01-13
Company data provided by crunchbase