Billing Specialist

Claims Review and Processing: Review claims prior to submission for coding accuracy, appropriate rate assignments, and completeness to ensure high standards of “clean claim” submissions, utilizing Candid Health’s RCM (“Candid”) platform Timely reviewing, processing, and submission of claims, tracking claims throughout their life cycle from pre-submission review to final provider payout. Managing Rejections, Denials, and Appeals: Resolves claim errors and/or discrepancies and expediently communicates any issues to plan EDI point-of-contact and relevant Mae personnel Resolves disputed claims by consulting with appropriate internal and external stakeholders Payment Timeliness and Adherence to Mae’s Service Level Agreements (SLAs): Monitors and tracks claim payments in Candid and flag for provider direct-payment accordingly Monitor and process payments Mae’s database for claims in queue for Priority Payout based on SLA requirements for timely payment Cross-Functional Reporting and Stakeholder Collaboration: Preparing reports for Mae’s Executive Leadership Team on claims trends, performance against SLAs, and identifying issues or concerns with claims adjudication that require further escalation