AmeriHealth Mercy Family of Companies Career Opportunities
How many years of claims experience do you have?
What is your knowledge of medical billing / coding?
Are you willing to work a flexible schedule including nights weekends and/or early mornings?
Please note that this position is no longer available.
If you would like to be considered for similar opportunities now or in the future, feel free to apply and/or set up a notifier for yourself.
Claims Examiner
PA - Philadelphia
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This is an exciting time to join the AmeriHealth Mercy Family of Companies (AMFC), as we are poised for strong growth in the rapidly expanding Medicaid market -- growth that will create opportunities for proven performers. As part of a team supporting multiple health plans around the country, you will leverage your skills in support of our mission of providing high quality healthcare solutions for the underserved. While we prefer that you bring relevant experience, this could be your opportunity to launch your career in claims processing. Quick question for you - click here In addition to a solid training program, AMFC offers competitive compensation and benefits, a beautiful facility convenient to both driving and public transportation, and onsite cafeteria and more.
 
AMFC is a national leader in health care solutions for the underserved. The company is among the largest organizations of Medicaid managed care plans and related businesses in the United States, touching the lives of more than 4 million individuals covered by Medicaid, Medicare, SCHIP and other insurance. AmeriHealth Mercy's programs offer improved health outcomes for members and have saved taxpayers millions of dollars.

The Requirements

To be a good fit for this opportunity you will have:
  • A high school diploma or GED; an associate's degree is preferred.
  • Knowledge of medical billing / coding, or related experience. Quick question for you - click here
  • One year of claims experience is preferred.
  • Working knowledge of PC applications in a Windows-based environment.
  • Healthcare or managed care experience is a plus.
  • Minimum 35 wpm keyboarding skill preferred.
Key competencies and success factors include the ability and willingness to:
  • Establish effective relationships, exhibit tact and consideration, and display a positive outlook and pleasant manner.
  • Adhere to a stringent schedule (begin work on time, keep absences within guidelines, return on time from breaks and meals, display flexibility regarding scheduling and schedule time off in advance).
  • Handle difficult customers effectively.
  • Display a high level of initiative and an action orientation.
  • Demonstrate effective listening skills.
  • Leverage strong analytical and problem solving skills.
  • Utilize a professional telephone speaking voice.
  • Perform well and maintain composure under stress.
  • Learn new skills, knowledge and systems quickly.
  • Multi-task, prioritize work and manage time.
  • Demonstrate effective oral and written communication skills.
We'll start you off with a training and orientation program that lasts from 6 to 11 weeks. During that time classes run five days a week from 8:30 AM to 5 PM, and you'll need to be available to attend the entire session. Once you assume your position your schedule and hours will vary and may include evenings, weekends and holidays. Quick question for you - click here Every employee is subject to a background check and drug screen.

The Role

You will join a large and diverse group that provides claims processing and customer service for seven (and growing) health plans in the US.  In a nutshell, you will review and adjudicate claims based on provider and healthplan contractual agreements and claims processing guidelines. More specifically, your activities will include:
  • Reviewing all claim types and applying processing rules to determine allowable benefits for payment adjudication. You'll review services for appropriateness of charges and system edits, and determine exclusions and denials based on contract provisions.
  • Suspending claims requiring additional information and / or special handling, and initiating action to obtain required information. This will involve forwarding claims requiring external department intervention to the appropriate department or person, and monitoring outstanding inquiries and working with management staff to identify and resolve areas of non-compliance.
  • Responding to and resolving healthplan claim inquiries, including monitoring and tracking aging, pending, and open claim reports to maintain timeliness in claims processing. You'll input claims into the system for appropriate tracking and adjudication; provide documentation, as appropriate, to support payment decisions; review and verify quality audit reports; and reconcile audit discrepancies, correct them in the system and make appropriate changes to avoid recurrence. 
  • Maintaining thorough knowledge of claims processing systems, databases and subsystems.
  • Identifying deficiencies / problems and adjusting behavior and work activities as appropriate. You'll follow internal processes and procedures to ensure activities are handled in accordance with departmental and company policies / procedures.
  • Meeting required production and quality standards.
  • Identifying and defining problems and opportunities within your work area and attempting to resolve them through appropriate channels. 
  • Responding to all written and verbal communications requiring attention including emails, phone calls and on-line help.
  • Creating and supporting an environment that fosters teamwork, cooperation, respect and diversity.
  • And more.
Note: this description is intended to give you a general overview of the position and is not an exhaustive listing of duties and responsibilities.

Why AmeriHealth

Great location-- you'll work in our corporate headquarters, an attractive facility (pictured) right off of Route 291 and near I-95; parking is free. We're also near public transportation, including the SEPTA Airport line. Because we are outside of Philadelphia, you won't be subject to the city wage tax unless you reside in Philadelphia.
 
Expansion through visionary leadership -- under the leadership of President and CEO Michael A. Rashid, AmeriHealth Mercy has embraced an ambitious strategy to build the reserves and infrastructure needed to achieve market leadership over the next five years. Rashid's vision: by 2015 AmeriHealth Mercy Family of Companies will be recognized as the national leader in developing health care solutions for the chronically ill and the underserved.

Doing it right-- you will find a strong sense of mission throughout AmeriHealth Mercy. We make money to serve the poor, while most of our competitors serve the poor to make money. Our people put a high value on the satisfaction they derive from helping improve the quality of life in our communities.

High quality, award winning products -- AmeriHealth Mercy offers quality health care products and services designed specifically to meet the changing health care needs and high expectations of our customers. For example, Keystone Mercy Health Plan, AmeriHealth Mercy Health Plan and Select Health of South Carolina all have received the highest possible accreditation by the national leader in HMO quality evaluation. The National Committee for Quality Assurance has awarded these HMOs "Excellent" status for meeting its rigorous evaluation standards.
 
Excellent benefits -- in addition to a competitive wage, we offer comprehensive benefits that include all you would expect as well as some pleasant surprises, such as health insurance that starts the first of the month after you start, a pension and 401(k) plan, generous holidays and paid time off and more.

Keys to Success

This is an excellent opportunity if you flourish in a structured environment and take pride in being reliable and professional. If you are the person we're looking for, you understand the importance of performing to productivity and quality standards. To thrive here you will learn quickly and be motivated to improve on a continual basis. We'll also look to you to remain flexible as priorities and needs change. In addition, you'll need to share our commitment to our mission: we help people get care, stay well and build communities; we have a special concern for those who are poor.

In addition we'll look to you to:
  • Establish and maintain positive communication and professional demeanor with other employees and clients at all times.
  • Adhere to organizational policies and procedures, as well as support and carry out the Mercy Mission and Values.
  • Demonstrate and support commitment to corporate goals and mission.

About AmeriHealth

The AmeriHealth Mercy Family of Companies (AMFC) is one of the nation's leaders in health care solutions for the underserved. AMFC operates in 12 states and serves more than four million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AMFC is a mission-driven company with nearly 30 years of experience serving low-income and chronically ill populations. AMFC's core products include full-risk HMOs, management contracts, administrative services, pharmacy benefit management, care management services and behavioral health care management services.
 
AMFC owns and operates four full-risk Medicaid managed care plans: AmeriHealth Mercy Health Plan (Harrisburg, PA); Keystone Mercy Health Plan (Philadelphia, PA); LaCare (Baton Rouge, LA); and Select Health, Inc. (Charleston, SC). Our extensive experience with Medicaid TANF and SSI populations makes us a leader in voluntary and mandatory Medicaid markets.
 
Our service is built on these values:
  • Advocacy
  • Care of the Poor
  • Compassion
  • Competence
  • Dignity
  • Diversity
  • Hospitality
  • Stewardship
The AmeriHealth Mercy Family of Companies delivers excellence in publicly funded managed care services and products.
This is an exciting time to join the AmeriHealth Mercy Family of Companies (AMFC), as we are poised for strong growth in the rapidly expanding Medicaid market -- growth that will create opportunities for proven performers. As part of a team supporting multiple health plans around the country, you will leverage your skills in support of our mission of providing high quality healthcare solutions for the underserved. While we prefer that you bring relevant experience, this could be your opportunity to launch your career in claims processing. Quick question for you - click here In addition to a solid training program, AMFC offers competitive compensation and benefits, a beautiful facility convenient to both driving and public transportation, and onsite cafeteria and more.
 
AMFC is a national leader in health care solutions for the underserved. The company is among the largest organizations of Medicaid managed care plans and related businesses in the United States, touching the lives of more than 4 million individuals covered by Medicaid, Medicare, SCHIP and other insurance. AmeriHealth Mercy's programs offer improved health outcomes for members and have saved taxpayers millions of dollars.

The Requirements

To be a good fit for this opportunity you will have:
  • A high school diploma or GED; an associate's degree is preferred.
  • Knowledge of medical billing / coding, or related experience. Quick question for you - click here
  • One year of claims experience is preferred.
  • Working knowledge of PC applications in a Windows-based environment.
  • Healthcare or managed care experience is a plus.
  • Minimum 35 wpm keyboarding skill preferred.
Key competencies and success factors include the ability and willingness to:
  • Establish effective relationships, exhibit tact and consideration, and display a positive outlook and pleasant manner.
  • Adhere to a stringent schedule (begin work on time, keep absences within guidelines, return on time from breaks and meals, display flexibility regarding scheduling and schedule time off in advance).
  • Handle difficult customers effectively.
  • Display a high level of initiative and an action orientation.
  • Demonstrate effective listening skills.
  • Leverage strong analytical and problem solving skills.
  • Utilize a professional telephone speaking voice.
  • Perform well and maintain composure under stress.
  • Learn new skills, knowledge and systems quickly.
  • Multi-task, prioritize work and manage time.
  • Demonstrate effective oral and written communication skills.
We'll start you off with a training and orientation program that lasts from 6 to 11 weeks. During that time classes run five days a week from 8:30 AM to 5 PM, and you'll need to be available to attend the entire session. Once you assume your position your schedule and hours will vary and may include evenings, weekends and holidays. Quick question for you - click here Every employee is subject to a background check and drug screen.

The Role

You will join a large and diverse group that provides claims processing and customer service for seven (and growing) health plans in the US.  In a nutshell, you will review and adjudicate claims based on provider and healthplan contractual agreements and claims processing guidelines. More specifically, your activities will include:
  • Reviewing all claim types and applying processing rules to determine allowable benefits for payment adjudication. You'll review services for appropriateness of charges and system edits, and determine exclusions and denials based on contract provisions.
  • Suspending claims requiring additional information and / or special handling, and initiating action to obtain required information. This will involve forwarding claims requiring external department intervention to the appropriate department or person, and monitoring outstanding inquiries and working with management staff to identify and resolve areas of non-compliance.
  • Responding to and resolving healthplan claim inquiries, including monitoring and tracking aging, pending, and open claim reports to maintain timeliness in claims processing. You'll input claims into the system for appropriate tracking and adjudication; provide documentation, as appropriate, to support payment decisions; review and verify quality audit reports; and reconcile audit discrepancies, correct them in the system and make appropriate changes to avoid recurrence. 
  • Maintaining thorough knowledge of claims processing systems, databases and subsystems.
  • Identifying deficiencies / problems and adjusting behavior and work activities as appropriate. You'll follow internal processes and procedures to ensure activities are handled in accordance with departmental and company policies / procedures.
  • Meeting required production and quality standards.
  • Identifying and defining problems and opportunities within your work area and attempting to resolve them through appropriate channels. 
  • Responding to all written and verbal communications requiring attention including emails, phone calls and on-line help.
  • Creating and supporting an environment that fosters teamwork, cooperation, respect and diversity.
  • And more.
Note: this description is intended to give you a general overview of the position and is not an exhaustive listing of duties and responsibilities.

Why AmeriHealth

Great location-- you'll work in our corporate headquarters, an attractive facility (pictured) right off of Route 291 and near I-95; parking is free. We're also near public transportation, including the SEPTA Airport line. Because we are outside of Philadelphia, you won't be subject to the city wage tax unless you reside in Philadelphia.
 
Expansion through visionary leadership -- under the leadership of President and CEO Michael A. Rashid, AmeriHealth Mercy has embraced an ambitious strategy to build the reserves and infrastructure needed to achieve market leadership over the next five years. Rashid's vision: by 2015 AmeriHealth Mercy Family of Companies will be recognized as the national leader in developing health care solutions for the chronically ill and the underserved.

Doing it right-- you will find a strong sense of mission throughout AmeriHealth Mercy. We make money to serve the poor, while most of our competitors serve the poor to make money. Our people put a high value on the satisfaction they derive from helping improve the quality of life in our communities.

High quality, award winning products -- AmeriHealth Mercy offers quality health care products and services designed specifically to meet the changing health care needs and high expectations of our customers. For example, Keystone Mercy Health Plan, AmeriHealth Mercy Health Plan and Select Health of South Carolina all have received the highest possible accreditation by the national leader in HMO quality evaluation. The National Committee for Quality Assurance has awarded these HMOs "Excellent" status for meeting its rigorous evaluation standards.
 
Excellent benefits -- in addition to a competitive wage, we offer comprehensive benefits that include all you would expect as well as some pleasant surprises, such as health insurance that starts the first of the month after you start, a pension and 401(k) plan, generous holidays and paid time off and more.

Keys to Success

This is an excellent opportunity if you flourish in a structured environment and take pride in being reliable and professional. If you are the person we're looking for, you understand the importance of performing to productivity and quality standards. To thrive here you will learn quickly and be motivated to improve on a continual basis. We'll also look to you to remain flexible as priorities and needs change. In addition, you'll need to share our commitment to our mission: we help people get care, stay well and build communities; we have a special concern for those who are poor.

In addition we'll look to you to:
  • Establish and maintain positive communication and professional demeanor with other employees and clients at all times.
  • Adhere to organizational policies and procedures, as well as support and carry out the Mercy Mission and Values.
  • Demonstrate and support commitment to corporate goals and mission.

About AmeriHealth

The AmeriHealth Mercy Family of Companies (AMFC) is one of the nation's leaders in health care solutions for the underserved. AMFC operates in 12 states and serves more than four million Medicaid, Medicare and SCHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services. Headquartered in Philadelphia, AMFC is a mission-driven company with nearly 30 years of experience serving low-income and chronically ill populations. AMFC's core products include full-risk HMOs, management contracts, administrative services, pharmacy benefit management, care management services and behavioral health care management services.
 
AMFC owns and operates four full-risk Medicaid managed care plans: AmeriHealth Mercy Health Plan (Harrisburg, PA); Keystone Mercy Health Plan (Philadelphia, PA); LaCare (Baton Rouge, LA); and Select Health, Inc. (Charleston, SC). Our extensive experience with Medicaid TANF and SSI populations makes us a leader in voluntary and mandatory Medicaid markets.
 
Our service is built on these values:
  • Advocacy
  • Care of the Poor
  • Compassion
  • Competence
  • Dignity
  • Diversity
  • Hospitality
  • Stewardship
The AmeriHealth Mercy Family of Companies delivers excellence in publicly funded managed care services and products.
AmeriHealth Mercy Family of Companies is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
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