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.

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 reconcile 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.
• Manage and process all ECRP provider appeals through the entire process.
• Report back to IBC any issues or activities related to provider appeals.
• Assist 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 :

Our Comprehensive Benefits Package :