Medical Claims Coordinator

4 days ago


Louisville, Kentucky, United States Elevance Health Full time

About the Role

As a Medical Claims Coordinator at Elevance Health, you will play a vital part in ensuring our members receive the best possible care. We are seeking an experienced professional to join our team as a Utilization Management Representative I. In this role, you will be responsible for coordinating cases for precertification and prior authorization review.

Your Impact

  • You will manage incoming calls or incoming post services claims work.
  • You will determine contract and benefit eligibility, providing authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.
  • You will refer cases requiring clinical review to a Nurse reviewer.
  • You will be responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.
  • You will respond to telephone and written inquiries from clients, providers, and in-house departments.
  • You will conduct clinical screening processes.
  • You will authorize initial sets of sessions to providers.
  • You will check benefits for facility-based treatment.
  • You will develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

Requirements

  • A high school diploma or GED is required.
  • A minimum of 1 year of customer service or call-center experience is preferred; or any combination of education and experience that would provide an equivalent background.
  • Medical terminology training and experience in the medical or insurance field are preferred.
  • FHPS experience is also preferred.

Benefits

  • This position offers a competitive salary range of $45,000 - $60,000 per year.
  • We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
  • Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
  • Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.


  • Louisville, Kentucky, United States Snelling Full time

    Looking for a dynamic and supportive work environment in the medical industry?About the JobWe are seeking a Medical Billing Specialist to join our team at Snelling in Louisville, KY. This temp-to-hire opportunity offers a chance to work with a leading company in the healthcare sector.The ideal candidate will be responsible for managing and processing billing...


  • Louisville, Kentucky, United States BrightSpring Health Services Full time

    We are seeking a skilled professional to fill the role of Pharmacy Claims Processor at PharMerica, a leading pharmacy services provider. In this role, you will be responsible for the accurate and timely adjudication of all prescriptions, as well as performing other clerical duties as assigned.The ideal candidate will have excellent customer service and...


  • Louisville, Kentucky, United States Orion Talent Full time

    Orion Talent, the nation's largest military recruiting firm, is a leader in connecting transitioning or former military professionals with top-notch opportunities in the industry. As a Warranty Claims Specialist, you will be part of a team that provides exceptional administrative support for warranty claims and issues to customers and internal team...


  • Louisville, Kentucky, United States Isaacs & Isaacs PSC Full time

    Company Overview">We are a leading personal injury law firm dedicated to providing exceptional representation to injured victims.">Salary">The starting salary is approximately $90,000 per year, with opportunities for commission-based earnings within the first year.">Job Description">This role involves handling motor vehicle accident cases in pre-litigation...


  • Louisville, Kentucky, United States Isaacs & Isaacs PSC Full time

    Job OverviewIsaacs & Isaacs PSC is seeking a highly skilled Personal Injury Claims Specialist to join their team. The ideal candidate will have 2 years of experience in personal injury law and be proficient in Microsoft Office.The selected individual will be responsible for handling pre-litigation personal injury claims from inception to settlement. This...


  • Louisville, Kentucky, United States Gallagher Full time

    About Us Gallagher is a leading insurance brokerage, providing innovative solutions to our clients. We're committed to delivering exceptional results and exceeding expectations. Job Overview We have an exciting opportunity for a Claims Resolution Specialist to join our experienced team in Kentucky. This role will involve investigating, evaluating, and...


  • Louisville, Kentucky, United States UofL Health Full time

    About the RoleAs a Commercial Claims Resolution Specialist at UofL Health, you will play a critical role in ensuring timely and efficient billing and follow-up processes for our patients. This position requires a strong understanding of commercial payer eligibility, benefits, and determining primary payers.Key ResponsibilitiesMonitor commercial and specialty...


  • Louisville, Kentucky, United States ASSOC IN PLASTIC SURGERY Full time

    Front Desk Coordinator Job SummaryWe are seeking a highly skilled and organized Front Desk Coordinator to join our team at ASSOC IN PLASTIC SURGERY.Compensation: $55,000 - $75,000 per yearThis is a full-time position working Monday through Friday with occasional overtime as needed. The ideal candidate will have previous experience in a medical office setting...


  • Louisville, Kentucky, United States BrightSpring Health Services Full time

    Job SummaryWe are seeking a highly skilled Medical Billing Specialist to join our team at PharMerica. As a key member of our revenue cycle operations, you will be responsible for ensuring the accurate and timely adjudication of prescriptions, onsite training of new hires, and maintenance of pharmacy unbilled claims.ResponsibilitiesEnsure the accuracy and...


  • Louisville, Kentucky, United States ASSOC IN PLASTIC SURGERY Full time

    Front Desk Coordinator Job DescriptionWe are seeking a highly skilled Front Desk Coordinator to join our team at ASSOC IN PLASTIC SURGERY.This full-time opportunity requires a customer-focused and detail-oriented individual who can provide exceptional patient care and administrative support to our medical staff.Estimated Salary: $55,000 - $70,000 per...


  • Louisville, Kentucky, United States Molina Healthcare Full time

    The Senior Business Analyst role at Molina Healthcare offers a unique opportunity to make a meaningful impact on the company's success. As a key member of the claims processing team, you will be responsible for providing regular, timely, and accurate reports to support business needs and critical functions. This position requires strong analytical skills,...


  • Louisville, Kentucky, United States Aligned Dental Partners Full time

    Role SummaryWe are seeking a highly organized and detail-oriented Dental Operations Coordinator to join our team at Aligned Dental Partners in Louisville. This is an excellent opportunity for individuals who enjoy working with patients and are passionate about delivering exceptional patient care.The successful candidate will be responsible for coordinating...


  • Louisville, Kentucky, United States CorVel Full time

    CORVEL is seeking a highly skilled Healthcare Risk Specialist to join our team. As a Healthcare Risk Specialist, you will be responsible for overseeing initiatives surrounding assessing the severity of reported injuries, reviewing medical data, and validating medical information. Your expertise will serve as a nurse consultant, supporting the goals of the...


  • Louisville, Kentucky, United States Insight Global Full time

    About the JobThe Insight Global company is seeking an experienced Billing Specialist to join our team. The ideal candidate will have a strong understanding of healthcare billing, private insurance or federally funded programs, and be able to work effectively in a fast-paced environment.Key Duties:Process and submit billings through various channels.Review...


  • Louisville, Kentucky, United States Ivan Ware & Son Inc Full time

    Job OverviewWe are seeking an experienced Human Resources Generalist to join our team and provide day-to-day HR support in our growing organization.About the PositionThis is a full-time, in-office position (Monday-Friday, 8am-5pm) with an estimated annual salary of $62,000. We offer a comprehensive benefits package including health, dental, vision, life, and...


  • Louisville, Kentucky, United States UofL Health Full time

    UofL Health: Medical Receptionist Job Description">We are seeking a dependable and professional Medical Office Coordinator to join our team at Jeffersontown Primary Care.About the Role:">This is a full-time position that requires excellent communication skills, attention to detail, and the ability to work in a fast-paced...


  • Louisville, Kentucky, United States Synchrony Health Services Full time

    Job DescriptionPrimary Responsibilities:• Run daily ECS log report to identify denied claims for Medicare or other insurers• Review and complete all denied claims in the ECS log for Medicare and other insurers• Request prior authorization on drugs that are denied for prior authorization• Obtain third-party insurance information on all...

  • Medical Assistant

    4 weeks ago


    Louisville, Kentucky, United States Commonwealth Pain & Spine Full time

    Job Opportunity About Commonwealth Pain & SpineWe are a fast-growing, progressive pain management group in Kentucky and Southern Indiana. Our team of board-certified physicians takes the time to educate our staff, and our brand-new facilities feature the latest technology. We foster a family-oriented culture with great hours, competitive pay, benefits, and...


  • Louisville, Kentucky, United States HealthTronics, Inc. Full time

    Compensation and Benefits: We offer a competitive bi-weekly base hourly rate of $25-$35 per hour, with opportunities for overtime pay. Additionally, we provide generous paid time off (PTO) and 15 days of PTO to start, up to 200 hours/year with tenure.About the Role: As a Patient Care Technician at HealthTronics, you will have the autonomy to manage medical...


  • Louisville, Kentucky, United States Family Allergy & Asthma Full time

    Job Title:Medical Office Coordinator - Front DeskAbout the Role:We are seeking a highly organized and detail-oriented Medical Office Coordinator to join our team. In this role, you will be responsible for providing exceptional patient care and ensuring seamless front desk operations.Key Responsibilities:Patient Check-In/Check-Out: Verify patient information,...