Job Description

Company Overview:

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities:

Acentra Health is looking for a Resolution and Adjustment Specialist (SCA) to join our growing team.

Job Summary:

The Resolution and Adjustment Specialist conduct bill-specific research and adjudicates claims accurately and promptly in accordance with OWCP policies.

***This position will require work to be performed on-site in Talahassee, FL one week a month, no exceptions*** 

Responsibility:

• Independently resolve suspended claims using the resolution screens in accordance with operational procedures
• Apply a “Forcible” disposition when appropriate to override edits and process claims per established guidelines
• Review and analyze claims independently to ensure accuracy and completeness
• Maintain accuracy and consistency throughout the claims‑processing workflow
• Train on and adhere to operational procedures and standard management practices
• Research and resolve medical bill data issues by comparing information with source documents to identify root causes
• Review and process paper and electronic bills submitted for adjustment in accordance with OWCP policies and procedures
• Review and process suspended claims and all related documentation
• Facilitate manual entry of claims into the system as needed
• Perform manual reviews on claims, documents, and attachments to ensure compliance and accuracy
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

The list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications:

Required Qualifications

• Hybrid work - one week a month on-site
• Possess a high school diploma or GED
• 3+ years of experience conducting research to resolve medical billing issues.
• Demonstrated knowledge of medical terminology, including diagnosis and procedure codes
• Familiarity with medical billing and claim forms, along with common coding schemes (certification preferred)
• Ability to efficiently navigate and operate multiple computer claims systems and software platforms simultaneously

Preferred Qualifications

• Knowledge of claims review and analysis
• Strong computer skills (MS Word and Excel)
• Excellent oral/written communication and organizational skills
• Ability to prioritize and manage time effectively

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

#LI-SF1

Pay Range: USD $20.85 - USD $26.06 /Hr.

Job Tags

Full time, Local area

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