CareNu Claims Processing Representative Hybrid/remote to Tampa office

Role:
The Claims Processing Representative for CareNu researches, and processes medical claims received from hospitals, hospital-based service providers, and community based providers and vendors.Qualifications:• High school diploma or GED; some college preferred or an equivalent combination of education and experience• Minimum of one (1) year experience in accounting or business office• Experience in healthcare field• Knowledge of third party billing and state and federal collection regulations preferred• Experience in Microsoft Excel and Word• Ability to prioritize and multi-task independently with little supervision• Must be self-motivated and service oriented• Excellent written and verbal communication skillsCompetencies:• Satisfactorily complete competency requirements for this position.Responsibilities of all employees:• Represent the Company professionally at all times through care delivered and/or services provided to all clients.• Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.• Comply with Company policies, procedures and standard practices.• Observe the Company's health, safety and security practices.• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.• Use resources in a fiscally responsible manner.• Promote the Company through participation in community and professional organizations.• Participate proactively in improving performance at the organizational, departmental and individual levels.• Improve own professional knowledge and skill level.• Advance electronic media skills.• Support Company research and educational activities.• Share expertise with co-workers both formally and informally.• Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.Job Responsibilities:• Processes claims returned by Third Party Administrator (TPA) for second level review.• Secures needed authorization or denial from clinical manager when applicable.• Ensures claims are processed in accordance with contractual terms and appropriate fee schedules.• Maintains a thorough knowledge of third party billing and reimbursement requirements.• Audits weekly Release For Funds (RFF) from TPA.• Handles incoming appeals, correspondence, and customer service calls.• Handles incoming and outgoing customer service calls.• Performs other duties as assigned.