Claims & Adjustment Specialist

Claims And Adjustment Specialist

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

We offer:

1. Work/life balance: We provide PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Opportunity to make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Skill development: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:

• Research, analyze, and determine appropriate outcome for provider carrier disputes based on company policies and procedures and regulations, while meeting quality and production standards as established by department director.
• Document and maintain claim appeal status in the claim appeal tracking tool.
• Send out applicable provider carrier dispute outcome letters, and other correspondence.
• Perform research and analysis on a variety of claim adjustments.
• Apply claims knowledge, company policies and procedures, and regulations to appropriately adjust claims.
• Manage and work daily claim pend reports.
• Finalize claims as needed and communicate with Cognizant on the status of daily pend reports.
• Submit, manage and follow up on Snow tickets associated with claims and appeals to Cognizant.
• Assist with auditing of special projects, as needed. Assist with department training of new employees.
• Serve as a back up to the Claims Coordinator and will log in claim appeals into the claim appeals tracking tool, when needed.

What you will bring:

Education: High School Diploma or equivalent required. Associates degree in health, social services or additional college courses preferred. Equivalent combination of experience and/or education may substitute with a preference for four years progressive relevant work experience.

Experience: Minimum of four years' healthcare experience. Three years of claims or appeals processing experience preferred.

Knowledge, Skills, and Abilities: Solid knowledge of claims payment and record keeping required. Must possess basic understanding of health care, medical terminology, medical procedures and managed care principles. Requires familiarity with all claim forms and coding types including CPT/HCPCS, ICD-10, HCFA 1500 and UB-92. Demonstrates support for the company's mission, vision and values. Excellent organization skills and decision-making skills required. Excellent written and verbal communications skills required. Must be able to interpret data and effectively summarize information. Knowledge of Microsoft Excel, Access & Word strongly preferred. May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access: The compensation for this position is $65,880.00 - $73,300.00 annually and is a non-exempt (hourly) position. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate's sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you'll receive a generous benefits package, that includes: Medical, dental, vision insurance that starts the first day of the month following start date. Supplemental insurance such as critical illness and accidental injury. Health care and dependent care flexible spending account options. Employer-paid basic life insurance and AD&D (employee, spouse and dependent). Short-term and long-term disability coverage. Voluntary life insurance (employee, spouse, dependent). Paid time off Retirement plan Tuition reimbursement (based on eligibility). Annual bonus program (based on eligibility, requirements and performance).

This position will be a hybrid model work environment, a blend of 'In-Office' and 'Remote.'

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.