DSNP Claims Coordinator

Job Summary

To support a growing healthcare team, the full-time remote DSNP Claims Resolution Coordinator will review, research, and resolve Dual Eligible Special Needs Plan (DSNP) claim inquiries while ensuring compliance with Medicare and Medicaid guidelines.

Key responsibilities:

• Review, research, and resolve assigned DSNP claim inquiries and provider correspondence using internal systems
• Determine appropriate claim actions, including payment, denial, or adjustment, in accordance with applicable guidelines
• Communicate and collaborate with various business partners to resolve claim issues and escalations effectively

Required qualifications:

• Associate's degree preferred
• At least 2-3 years of healthcare claims experience required
• Knowledge of medical billing, coding principles, and insurance claim submission processes
• Familiarity with Medicare, Medicaid, and applicable billing requirements
• Strong customer service orientation and ability to handle sensitive situations with professionalism