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Allentown, PA
Claims Adjudicator

Claims Adjudicator

AblePay Health LLC

Posted 2 months ago, valid for 17 days

Allentown, PA, US

Competitive

Full Time

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Sonic Summary

The Claims Adjudicator position involves evaluating claims from billing providers for data integrity and validating Patient Responsibility before processing them to the secure Member Portal.
Key responsibilities include processing electronic and paper claims daily, verifying their accuracy, and resolving discrepancies in a timely manner.
The role requires establishing strong relationships with billing providers, Members, and internal staff while assisting Members with disputes and billing questions.
Additionally, the Claims Adjudicator negotiates discounts on out-of-network claims and performs other duties as assigned by management.
Candidates should have at least 2 years of relevant experience, with a salary range of $45,000 to $55,000 per year.

The Claims Adjudicator position is responsible for assuring claims received from billing providers are evaluated for data integrity and validating the Patient Responsibility before processing to the secure Member Portal; building and maintaining outstanding relationships with providers.

Job Duties/Essential Functions:

Processes electronic and paper claims on a daily basis.
Verifies and reviews claims received are accurate before adjudication.
Reviews and resolves claim discrepancies in a timely manner.
Contacts billing providers to correct AblePay Member ID and insurance information as needed.
Establishes a working relationship with billing providers, Members, and internal staff.
Assists Members on any related dispute/issue as authorized.
Assists Members with general billing questions.
Contacts medical providers to negotiate the greatest discount/savings on out of network claims.
Performs other related duties as assigned by management.

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