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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Perform claim audits and report on results to identify training needs and system or process issues. Research policy, network, contract reimbursement and claims processing guidelines to determine accuracy of processing. Accurately interpret benefit and policy provisions applicable to fully-insured group/individuals and self-funded clients. Reprocess claims due to processing errors, setup/system errors, eligibility updates and other retro changes. Review corrected claims from providers and facilities to determine if they meet standards for required documentation, content, and timeliness and reprocess or communicate denial as necessary. Responsible for identifying overpayments, preparing recovery requests, and performing follow-up tasks on outstanding overpayments. Provide customer service to internal and external customers regarding overpayment transactions. Provide support to internal staff regarding claims processing rules and procedures.
Essential Responsibilities:
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