Job Description:
As a Data Entry Resolutions Specialist at Infocrossing INC, you will play an essential role in maintaining the accuracy and integrity of Medicaid claims processing. Your primary responsibility will be to resolve suspended MO HealthNet claims and their associated attachments through detailed evaluation, staging for review, and precise data entry within our electronic Medicaid Management Information System (eMMIS).
Your daily duties will include:
- Thoroughly analyzing exception test pages to accurately determine if claims and attachments should be approved or rejected, ensuring compliance with relevant regulations and internal standards.
- Coordinating with medical consultants by staging claims and attachments that require clinical judgment, facilitating an efficient review process.
- Communicating clearly with healthcare providers to explain determinations regarding their claims, fostering transparency and improving provider relations.
- Utilizing EOB (Explanation of Benefits) codes to document resolutions accurately within the eMMIS platform for payment authorization or claims denial.
- Keeping pace with updates in Medicaid policies, system edits, and audit processes to maintain relevance and accuracy in claim resolution.
This position requires an individual with strong analytical skills, diligent attention to detail, and the capacity to make well-informed decisions based on systematic data review. You will collaborate closely with cross-functional teams to enhance the claim processing cycle, thereby contributing directly to the operational excellence of BPS-IHS.
We emphasize continuous learning and provide opportunities to develop within a fast-evolving healthcare administration environment, positioning you to broaden your expertise in Medicaid claim adjudication.
Core Competencies:
- Client Centricity: Demonstrate a strong commitment to understanding and addressing the needs of healthcare providers and stakeholders.
- Passion for Results: Maintain enthusiasm and dedication toward achieving accurate, timely, and compliant claim resolutions.
- Execution Excellence: Ensure all assigned tasks meet quality standards through disciplined work habits and adherence to procedural guidelines.
- Collaborative Working: Engage proactively with medical consultants, providers, and team members to foster a supportive and transparent work environment.
- Learning Agility: Embrace continuous improvement by adapting quickly to changes in Medicaid regulations, system updates, and process enhancements.
- Problem Solving & Decision Making: Apply critical thinking to evaluate complex claims data and make informed determinations.
- Effective Communication: Convey findings and resolutions clearly and professionally, whether in writing or verbal interactions with providers and colleagues.
These competencies form the foundation of success in this role and align with our organizational values of integrity, accountability, and teamwork.
Additional Information
The role of Data Entry Resolutions Specialist is integral to maintaining the integrity and efficiency of MO HealthNet Medicaid claims processing. This position demands precision, accountability, and a proactive approach to challenges.
Successful candidates will benefit from comprehensive training programs designed to enhance technical competence and policy knowledge. We provide a supportive environment where continuous feedback and collaboration are encouraged to help you excel in your role.
The work environment is fast-paced and driven by deadlines, requiring effective time management skills. You will also have opportunities to work closely with healthcare professionals and internal consultants, enriching your exposure to the healthcare industry’s operational intricacies.
At Infocrossing INC, we value transparency, respect, and inclusion, ensuring every team member can contribute to their fullest potential in a welcoming environment.
Join us to help shape the future of healthcare services and realize your ambitions with a company on the cutting edge of digital transformation.
The expected compensation for this role ranges from $32,000 to $34,000 annually.
Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro’s standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
