Inclusa is seeking a
Authorization & Claims Support Specialist
who is a self-starter with strong organizational skills, judgement and independent decision making abilities. We desire a colleague that is able to maintain professional and service-oriented relationships that align with our vision, 'The innovative leader in building vibrant and inclusive communities, Inclusa empowers full and meaningful lives of those we serve. Application Deadline:
Monday, October 17th.
Under the supervision of the ACA SupportTeamManager,the AC SupportSpecialistisresponsible for the day-to-dayauthorization and claimsprocessing andsupport.TheAC SupportSpecialistwill partner withother stakeholderstoensure excellent customer service is provided to members/providers, and services/supports are authorized and paid for in an accurate and timely manner.
Authorization & Claims Support Specialist (AC Support Specialist) duties include:
Processand support authorization entry for member services/supports in accordance with guidelines, policy and procedures.
- Engage in training onauthorizationrelatedguidelines, policy, and procedures and become proficient in their content.
- Engage in training on applicable systems and technology to enhance productivity.
- Enter the correct amount, frequency, and coding for the appropriate services from the referral or other source documentation in a timely manner.
- Routinely meet established authorization entry benchmarks and goals.
- Research referral errors and/or omissions and seek resolution in a timely manner.
Provide claims supportfor member services/supports in accordance with guidelines, policy and procedures.
- Engage in training onclaimsrelated guidelines, policy, and procedures and become proficient in their content.
- Engage in training on applicable systems and technology to enhance productivity.
- Collaborate with WPS and other stakeholders to support timely provider claim payment andtoreduce the frequency of claim rejections or denials.
- Researchclaimerrors and/or omissions and seek resolution in a timely manner.
- Research and support authorization and claim audit and appeal activities.
Who is Inclusa?
Inclusa through its founding organizations, pioneered Family Care in Wisconsin and has been serving the people of Wisconsin since 2000. We are presently in 68 counties servicing nearly 16,000 members, the frail elderly and adults with disabilities, in a strengths-based manner that supports goals and what is important for each individual.We promote a culture of coaching to success. Your professional development is viewed as paramount to our growth and reputation. We strive to see you succeed and grow, both personally and professionally. In addition to working in a team focused and collaborative work environment, you would be offered robust benefits options.
**Candidates are able to work remotely anywhere in the state of WI.
Deadline Date: We will be accepting applications for this position Monday, October 17th.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)