[New Job Vacancy] Claims Adjudicator II-1 job in Evolent Health, (Remote) – Jobs in Remote

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Job Opening details:-
Company Name :-
Evolent Health
Position Name :-
Claims Adjudicator II-1
Company Location :-
Remote
Job Category :
 Back office jobs

Full Job Description :-
Your Future Evolves Here

New Century Health (NCH) has been transforming the delivery of specialty care and driving radical cost and quality improvement across the member journey for patients with cancer and cardiovascular disease. As part of Evolent Health, we are on a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Why We’re Worth the Application:

We continue to grow year over year.
Recognized as a leader in driving important

diversity, equity, and inclusion (DE&I) efforts
.
Achieved a 100% score two years in a row on the

Human Rights Campaign’s Corporate Equality Index
making us a best place to work for LGBTQ+ equality.
Named to Parity.org’s

2020 list of the best companies for women to advance
.
Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.
Published an annual

DE&I report
to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:

SCOPE & RESPONSIBILITIES OF ROLE

This position plays a vital role in the team’s mission to create and sustain added value to NCH, its Network Partners, Providers, Members and Fellow Colleagues by consistently demonstrating professionalism and excellent customer service. Responsibilities of the role include delegating the day-to-day workload to the Claims team; Resolves incoming telephone, fax, or email from providers to communicate updates on claims authorization request status, eligibility, appeals, and other inquiries; Manages the daily claims inventory to track the Claims team’s progress; Performs data entry and filing; Stores and tracks all paper documentation in accordance with regulatory requirements. Prepares files to assist with audits; and assists adjudicators with claims validation and adjudication as needed.

KNOWLEDGE, SKILLS & ABILITIES

Ability to manage time effectively and prioritize the daily work flow
Strong organizational skills
Skilled at anticipating and exceeding customer service needs
Ability to communicate and collaborate with internal and external stakeholders
Knowledge of CPT and ICD-10 codes, medical terminology, and CMS regulations
Basic analytical and problem-solving skills
Close attention to detail with a high level of accuracy

EXPERIENCE, EDUCATION, LICENSES & CERTIFICATIONS

1 year of experience in a Managed Care environment (required)
Experience with claims inventory and document management (preferred)
High School Diploma or GED (required)
Proficient in Microsoft Office – Word, Excel, and Access

ESSENTIAL JOB FUNCTIONS

Specific vision abilities, including close vision, operate computer screen for extended periods of time
May be required to sit or stand for extended periods of time
May be required to occasionally lift or move up to 25 pounds
Ability to read, write and speak the English language fluently with patients and providers

Technical Requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range: The minimum salary for this position is $52,000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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