- Receives and monitors the completeness and accuracy of claims forms and supporting documentation submitted by healthcare providers. - Enters claim information, such as patient information, provider details, procedure codes, and diagnosis codes, into the company's claims processing system. - Documents relevant information for the eligibility of the claim, determining coverage and benefits, and assessing the validity and medical necessity of the services rendered. - Calculates claim payments based on the approved reimbursement rates, fee schedules, or contracted rates with healthcare providers.

Respond to incoming calls, emails, chats, SMS text, from general public, clinicians and government officials in accordance with all CDC and Maximus performance standards, policy and procedures, and protocols including but not limited to the confidentiality and privacy policy - Calls, emails, chats, vaccine appointments and sending out kits are predominantly routine, but may require deviation from standard screens, scripts, and procedures - Utilize databases and written materials to look up and provide requested information or task.

- Accurately enter and update patient data in internal and client-facing systems  - Access and navigate multiple EMR platforms to retrieve, validate, and process patient health information (PHI)  - Ensure data accuracy and consistency while meeting productivity benchmarks  - Maintain strict confidentiality and comply with HIPAA and company privacy policies  - Collaborate with team members to support process improvements and service quality

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https://careers.amerihealthcaritas.com/us/en/job/44033/Appeals-Grievance-Case-Resolution-Team-Lead