Claims Eligibility Representative in Brentwood, TN at Corizon Health

Date Posted: 10/1/2018

Job Snapshot

Job Description

Correctional Care | Committed Careers | Corizon Health

We have an exceptional opportunity for a Claims Eligibility Representative to join our Healthcare Support Team in Brentwood, TN.

Qualifications of the Corizon Health Claims Eligibility Representative

  • One (1) year experience in claims eligibility in a managed care environment.
  • 1+ years' experience in processing medical claims, knowledge of ICD-9, CPT-4, HCPCs, and ADA guidelines, medical terminology, fee schedules and contracts preferred
  • Data entry, 10-key skills, Microsoft Outlook, Excel, Word, QNXT system experience preferred
  • Read and comprehend simple instructions, short correspondence and memos. Write simple correspondence. Effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
  • Common sense understanding to carry out instructions furnished in written, oral or diagram form. Deal with problems involving several concrete variables in standardized situations.

Responsibilities of the Corizon Health Claims Eligibility Representative

Ensure claims are paid according to the eligibility and service date requirements. Research and verify records for UM additions/updates to the case management system, customer service requests, vendor inquiries and site personnel requests.


  • Add new demographic data and update existing data in the eligibility database according to information received from authorizations and other sources.
  • Interface with UM Nurses, Claims Examiners, and Customer Service Reps, Accounting and site personnel to ensure the accuracy of inmate eligibility.
  • Research daily exception reports generated from the InSite application.
  • Troubleshoot and resolve issues of conflicting data in the eligibility files, including but not limited to:

  • Duplicate eligibility entries
  • Other insurance coverage
  • Alias/alternate spelling of name
  • Date of birth
  • Dates of incarceration and release from custody

  • Prepare EXCEL spreadsheets requesting data; submit to correctional facilities and follow-up to ensure resolution in a timely manner.
  • Maintain thorough knowledge of the automated claims processing system's eligibility database and the impact on accurate claims adjudication.
  • Initiate calls to providers, site personnel, UM Nurses and other contacts as necessary to obtain and/or verify accurate custody information and history.
  • Access DOC offender tracking systems when available for research of eligibility issues.
  • Research and update records based on quarterly audits of automated eligibility feeds received from various DOC's.
  • Maintain productivity and quality standards as set forth by management.
  • Assist in completion of special projects on an as needed basis within the Department.
  • Assist in completion of special projects and initiatives on an as needed basis.

  • Benefits offered to the Corizon Health Claims Eligibility Representative

    • Paid Time Off
    • Medical, Dental and Vision Insurance
    • Tuition Assistance
    • 401(k) with Company Match
    • Comprehensive Onboarding

    Corizon Health provides patients with high quality healthcare and reentry services that will reduce recidivism and better the communities where we live and work. We are dedicated to meeting the needs of the growing number of incarcerated persons with physical and mental illness and the professionals who care for them. More healthcare professionals are finding the stability and advancement they desire at Corizon Health.

    This position may require a background check, security clearance, and/or drug screening.

    Corizon Health is an Equal Opportunity Employer. In compliance with federal and state employment opportunity laws, qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, Vietnam era veteran, or disabled Veteran status.

    IND