Claims Liaison

Location: Harrisburg, PA
Date Posted: 02-01-2019
Claims Liaison – Managed Care 
Harrisburg, PA
*** This is a Full-Time, Benefits Available, CONTRACT opportunity expected to last 6+ months! ***
Claims Liaison Job Summary:
  • Audit check run and send claims to the claims department for corrections
  • Identify any system changes and work notify the Plan Manager to ensure its implementation
  • Collaborate with the claims department to price pended claims correctly
  • Document, track and resolve all plan providers’ claims projects
  • Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
  • Identify authorization issues and trends and research for potential configuration related work process changes
  • Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
  • Identify potential and documented eligibility issues and notify applicable departments to resolve
  • Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
  • Run claims reports regularly through provider information systems
  • Research verbal and written providers’ claims inquiries as needed
  • Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.
  • Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available resources
  • Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

Claims Liaison Background Profile:
  • Requires graduate of high school or equivalent education; Associate degree preferred.
  • Certified Professional Coder (CPC) certification preferred.
  • At least 3 years of claims processing, provider billing, or provider relations experience, preferably in a health plan environment.
  • Proficient in Excel, and knowledge of provider contracts/reimbursement interpretation preferred.
    Experience with PA Medicaid billing/claims required.
  • Strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail.
  • Ability to interpret, analyze and summarize large data sets and develop reports.
  • Basic computer skills required, to include Microsoft Office, healthcare software, and data entry.
410.885.4745 (CALL – TEXT – FAX)

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