Medical CoPay Claims Processor

AssistRx

Louisville (KY)

On-site

USD 48,000 - 56,000

Full time

14 days+

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Benefits offered by this job

Competitive pay structure

Matching 401(k) with immediate vesting

Medical, dental, and vision insurance

Job summary

A healthcare service provider located in Louisville, Kentucky is seeking an Entry-Level Medical Claims Processor. This full-time role involves processing medical copay claims, collaborating with various teams, and ensuring timely submissions. Ideal candidates should have strong communication skills and familiarity with medical reimbursement, alongside a supportive workplace culture and competitive benefits.

Qualifications

Preferred college degree or equivalent experience.
Experience with HICF forms and EOBs.
Strong understanding of Medicare and Medicaid.

Responsibilities

Process medical copay claims following business rules.
Perform outbound calls to collect missing information.
Ensure accuracy in claim processing for submissions.

Skills

Medical Reimbursement experience

Claims processing

Communication skills

Problem-solving skills

Education

College degree or high school diploma with experience

Tools

Microsoft Office Suite

Job description

This range is provided by AssistRx. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$48,000.00/yr - $56,000.00/yr

DUTIES AND RESPONSIBILITIES:

Processes medical copay claims in accordance with program business rules.
Liaison with other program-specific AssistRx resources to secure outcomes for active patients
Performs outbound calls to inform and collect missing information
Ensures accuracy with attention to detail for copay claim processing and additional data collection
Performs other related duties as assigned by management
Perform daily reconciliation of batch postings, including automated/manual claim inputs
Analyze claims for accuracy based on insurance coverage, cost of goods, allowable amounts, and copays
Troubleshoot rejected claims and process prior authorizations or overrides
Maintain working knowledge of prescription plans and billing policies to ensure compliance and reimbursement
Monitor profitability of orders, manage claim queues (e.g., 3 & 5, 541, B queues), and adjust last events accordingly
Ensure timely claim submissions and adherence to adjudication and delivery windows
Coordinate with the Financial Assistance Department for additional funding when necessary
Promptly report reimbursement changes, underpayments, pricing discrepancies, or cost assistance needs

Requirements

College degree is preferred or a high school diploma with equivalent combination of education and experience
Other skills required:

Previous work experience in Medical Reimbursement including HICF forms and EOBs
Comprehensive understanding of Explanation of Benefits and application of patient benefit including HCPCs level II and CPT codes
Processing claims and resolving denial instances
Calculate patient responsibilities for copay reimbursement for services provided as outlined within the program business rules
Strong understanding of Government benefits such as Medicare, Medicaid, and Tricare
Documenting and reporting payment information
Professional level skills in computer use, including but not limited to Microsoft Office Suite, web-based applications, and keyboard skills
Demonstrated strong written and verbal communication skills with providers, patients and insurance companies
Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics
Problem solving skills

COMPETENCIES:

Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed
Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values

Benefits

Supportive, progressive, fast-paced environment
Competitive pay structure
Matching 401(k) with immediate vesting
Medical, dental, vision, life, & short-term disability insurance

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire

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