Atlanta, United Statesfull timeMid Level$70K–90K
posted 21 days ago
Role Overview
Key Responsibilities:
Experience Required:
o Member eligibility and benefit verification
o Provider validation (NPI, NCPDP ID)
o Real-time POS claims adjudication
o Pricing logic (ASC, Rates, TPL, copay, Service Authorization, reference data pricing) .
Experience in testing scenarios involving:
o Claims Adjudication / EDI
o Prior Authorization (PA)
o Formulary and benefit plan rules
o Claims Pricing.