ECRP Analyst / Liaison

Job Opportunity At AmeriHealth Caritas

At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs.

AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities :

Under the direct supervision of the Operations Supervisor, responsible for investigation and data entry associated with all out of area ECRP claims processing, adjustments, and communications with IBC and Plan Providers. Provides telephone customer service to internal and external clients on the ECRP Hotline. Works to reconcile all reports on a daily basis.

• Researches and reconciles invalid Members for claim submission to the Facet processing system.
• Assists Provider Network Management area with reconciliation of invalid providers inquiries related to claim submissions and crossing over into the Facets processing system.
• Manages and processes all ECRP provider appeals through the entire process.
• Reports back to IBC any issues or activities related to provider appeals.
• Assists in the training of ECRP claims processing.
• Maintains a tracking log of all Plan to Plan telephone inquiries.
• Assists department and company in managing ECRP inventories by effectively meeting IBC / Blue Card deadlines.
• Handles internal and external Plan to Plan telephone calls from IBC and Customer Service to update claim inquires.

Education / Experience :

Three years experience in a relevant area of claims processing and or customer service preferred. In-depth knowledge of claims payment methodology required. Associate's Degree or equivalent work experience. Bachelor's Degree preferred. Healthcare or Managed Care experience preferred. Minimum 45 wpm typing preferred. Working knowledge of PC applications in a windows based environment.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement and more. Phila BST