Claims Eligibility Specialist

Job Summary:

The Claims Eligibility Specialist is the point of contact for the Provider community to resolve issues related to Medicaid coverage and services. The incumbent coordinates and collaborates with internal associates and staff from various Provider agencies on Medicaid eligibility and claims issues. In addition to resolving discrepancies in coverage, eligibility, enrollment, and billing, the Claims Eligibility Specialist reviews, researches, and investigates claims and authorization data to support the analysis and identification of trends.

*** Must live local to Robbinsville, New Jersey ***

Education/Experience:

• High School Diploma or equivalent required

Requirements:

• Minimum one (1) year of experience in Medicaid Claims and Billing Process required.

• Current/recent in-depth knowledge of coverage and services offered under the Behavioral Health Medicaid Program regarding authorizations, claims, billing, enrollment, and eligibility preferred

• Customer service experience, preferably in a healthcare setting

• Experience working in Microsoft Office (Excel, Word, and Outlook)

• Strong attention to detail

• Ability to quickly and successfully embrace change and adapt effectively in response

• Effective communication (listening, verbal, and written) and critical thinking skills

• Experience working with an Electronic Medical Record (EMR) preferred

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, Paid Time Off (PTO), including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we would like to hear from you.

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.