Claims Processor II

Responsibilities

• Maintains accurate and timely processing of UB, HCFA and Dental claims submitted by external providers.
• Monitors and processes claim audits to maximize accuracy and minimize expense.
• Interacts with external providers, vendors, and external agencies on claims-related issues.
• Trains providers and addresses provider appeals according to CMS and NCCI guidelines.
• Clears pended claims through research and system updates/corrections.
• Downgrades DRG claims and reprocesses as directed by InnovAge’s external audit vendor.
• Processes provider refunds, coordinating and reconciling activity with Accounts Payable.
• Answers claims questions from customers, verifying eligibility, benefits, billing, and payment.
• Maintains Smart Data claims activity, resolving issues and making necessary adjustments.
• Conducts weekly batch reviews, monitoring internal reports to ensure claim payments accuracy.
• Loads new providers to InnovAge’s PCM Network to facilitate claims processing and payment.
• Works with Center Leadership to approve claims from non-contracted providers, as needed.
• Researches and resolves provider reconciliations to address billing/payment issues.
• Maintains provider fee schedules and trains external providers on claim execution.
• Processes refunded payments back to the claims system, ensuring accurate reconciliation with Accounting.
• Reviews and adjusts claims audits generated by Virtual Examiner and Varis.
• Responds to provider appeals, researching claims and drafting responses.
• Solves claims issues through conversations with participants, physicians, facilities, and others.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Trains external providers on executing CMS UB04, HCFA, or Dental claims as necessary.
• Manages provider fee schedule maintenance for Housing providers.
• Performs IP audits generated by Plexis and adjusts claims accordingly.
• Communicates with AP to submit invoices.
• Loads key paper claims activity into KL.
• Clears pended claims.
• Pulls daily reports to research and resolve issues preventing claim processing.
• Works with Center Leadership to approve claims from non-contracted providers.
• Resolves provider reconciliations to address billing/payment issues.
• Tr