National Association of Latino Healthcare Executives · 17 hours ago
Claims Examiner – Must Reside in Colorado
Denver, CO
Full-time
Onsite
Mid LevelNational Association of Latino Healthcare Executives is seeking a Claims Examiner to adjudicate managed healthcare claims and authorizations. The role involves analyzing claims, communicating with providers and members, and ensuring compliance with regulations.
Health CareHospitalMedical
Responsibilities
For all lines of business analyze claim holds/pends, research and track required claim information to adjudicate professional and hospital claims/bills
Proactive and or responsive outreach to provider, members and other customers that could include phone calls, emails or other methods as needed
Proactively communicate with internal departments as appropriate to resolve claims issues promptly
Provides input to supervisor and training and development team regarding training and educational tools to enhance department production and processes
Proactively communicate with internal departments as appropriate to resolve claims issues promptly
Provides assistance to prepare materials as needed to the leads, supervisors and managers for external audits
Communicate problems and/or trends to leads and management
Understand and apply county, state and federal regulations
Other duties as assigned within department job functions
Qualification
Required
Must reside in Colorado
Comprehensive assessment and analysis skills
Knowledge of managed healthcare claims/bills processing
Understanding of medical regulations
Ability to verify and update data into computerized systems
Ability to analyze claim holds/pends
Research and track required claim information
Proactive and responsive outreach skills
Effective communication skills with providers, members, and customers
Ability to communicate with internal departments to resolve claims issues
Ability to provide input regarding training and educational tools
Assistance in preparing materials for external audits
Ability to communicate problems and/or trends to management
Understanding and application of county, state, and federal regulations
Company
National Association of Latino Healthcare Executives
The National Association of Latino Healthcare Executives is a hospital and healthcare organization.
Founded in 2005
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Jackie Sifuentes, MBA, LSSYB
Co-Founder La Mesa Emerging Leaders Mentorship Program for Early Careerists
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