Adjudication Representative

<b>At LogistiCare, you have the ability to define your own career journey and enjoy the ride along the way and make possibilities real. Your growth is our objective. Whatever your passion, you’ll have the opportunity to find the career you’re looking for, learn and grow in your role, and make a difference in the lives of others. And you’ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first. <br/><br/>Sound like a good career fit? </b>

Tempe, AZ


<strong><a href="" target="_blank" rel="noopener noreferrer">Who We Are: Transportation &amp; Integrated Health Services</a><br /></strong>Nation&rsquo;s largest manager of non-emergency medical transportation, provides 69+ million rides annually in 39 states and D.C. Supports integrated health care programs, improving care coordination for members and their corresponding providers and hospital networks.<br /><br /><strong>What We Value Most &ndash; YOU<br /><br />Benefits - The Whole Package&nbsp;</strong><br />Medical, Vision, Dental, Disability, EAP, Legal, Voluntary Life Insurance, Group Life &amp; AD&amp;D, Flexible Spend Account, Paid STD &amp; LTD, Vacation &amp; Holidays<br /><br /><strong>Culture - Why You Want to Come to Work Every Day</strong><br />Casual Dress - Business Casual, Relaxing - Comfy Lounge Areas, Excitement -Themed&nbsp; Luncheons, Great Hours &amp; Set Shifts - (Mon. &ndash; Fri.)<br /><br /><strong>View Featured Positions Below OR Check Out <a href=";d=ExternalCareerSite" target="_blank" rel="noopener noreferrer">All&nbsp;Career Journey Opportunities&nbsp;with LogistCare</a></strong>

keywords: professional,analysis,benefits,claims,call center,experience,work environment,education,skills


Overview: The Adjudication Representative is responsible for pre-billing, patient account billing, and patient account collections. This job involves heavy computer use and public telephone contact.
Responsibilities: <p><strong>Essential Duties &amp; Responsibilities:</strong></p> <ul> <li>Determine if claim should be billed to 3rd party payer or as a private pay.</li> <li>Verify eligibility and covered benefits with insurers for all provider claims for non-contracted transports or for contracted transports not verified by the call center.</li> <li>Identify provider claims that should be questioned for Coordination of Benefits.</li> <li>Check accuracy of charges submitted for payment including fee schedule type, diagnosis, mileage, supplies and appropriate level of service.</li> <li>Obtain billing authorizations, when required, for all non-contracted transports or contracted transports not previously obtained from the call center.</li> <li>Enter claims into Logisticad (Logisticare's proprietary software) that fall outside of the normal process.</li> <li>Obtain correct billing address information.</li> <li>Determine potential MRU claims.</li> <li>Other duties as assigned.</li> </ul> <p>Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.</p>
Requirements: <p><strong>Education:</strong></p> <ul> <li>Qualified candidates must have a High School diploma or have a General Education Degree (GED).</li> </ul> <p><strong>Experience:</strong></p> <ul> <li>Prior insurance or billing experience in medical environment preferred.</li> <li>Prior book-keeping experience or claims processing experience preferred.</li> <li>Prior customer service experience preferred.</li> <li>Prior collections experience preferred.</li> </ul> <p><strong>Skills:</strong></p> <ul> <li>Experience using internet search tools and Microsoft Office.</li> <li>Excellent oral and written communication skills.</li> </ul> <p><strong>Competencies:</strong></p> <p>Communication, Oral - Ability to communicate effectively with others using the spoken word</p> <p>Interpersonal - Ability to get along well with a variety of personalities and individuals</p> <p>Detail Oriented - Ability to pay attention to the minute details of a project or task</p> <p>Organized - Possessing the trait of being organized or following a systematic method of performing a task</p> <p>Time Management - Ability to utilize the available time to organize and complete work within given deadlines</p> <p><strong>Environmental and Working Conditions:</strong></p> <ul> <li>Entire work time is conducted in an office setting.</li> </ul> <p><strong>Physical and Mental Requirements:</strong></p> <ul> <li>Ability to work independently or with a team a must.</li> </ul>