Appeal Resolution Specialist jobs in Tallahassee, FL

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health

Acentra Health is currently looking for Adjustment & Resolution Representative with experience in Claims/Billings to join our Tallahassee team!

The Adjustment & Resolutions Representative will assist with bill-specific research to resolve outstanding issues for a Federal Worker’s Compensation Program. You will also participate in guidance on this program and assist with departmental inventory management, identifying trends, and work assignments for staff.

You will have an opportunity to become diverse in a variety of claim types as you grow with our team!

*Candidate Must be able to work out of the Tallahassee, FL office facility.

**This is a Federal Contract: you will be required to pass a federal background check and fingerprinting before you can start**

Responsibilities:

• Review submitted bills requesting adjustment consideration, and research as needed to determine outcome
• Research and Resolve medical bill data, making necessary corrections of information by comparing data with source documents to identify root causes
• Request additional information as needed to complete the adjudication of bills.
• Make appropriate bill adjustment into the claims system according to contractual requirements and timelines
• Process bills according to Government policies and procedures.
• You will possess an unwavering commitment to customer service and operational excellence

Required Qualifications/Experience

• High school diploma or GED with at least five (5) years experience conducting research to resolve issues within the healthcare field
• Expert knowledge of medical terminology including medical diagnosis and procedure codes
• Familiarity with medical bill/claim forms, ICD-9/10CM coding, CPT coding, bill forms, and other medical coding schemes (certificate desired).
• Ability to simultaneously maneuver through various computer claims and eligibility platforms

Preferred Qualifications/Experience

• General knowledge of Workers Compensation and medical terminology
• Outstanding customer satisfaction skills

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.  

Compensation 

“Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.