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Claims Adjudication Spec

Advocate Physician Partners (APP) brings together more than 4,000 physicians who are committed to improving health care quality, safety, and outcomes for patients across Chicagoland and Central Illinois. APP is a leader in population health management and has garnered wide-spread national recognition for its innovative clinical integration program.  Formed as a care management collaboration with Advocate Health Care, APP supports its physician members in managing the health of their practices with contracting, medical management, electronic medical records and other value-added services.

What You Will Do:
Claims Adjudication Specialists have direct contact with physicians and management of hospital, ancillary and provider billing organizations. They resolve issues within APP and will provide consultation to providers and their support teams regarding opportunities for improvement. This role requires a very high degree of credibility when performing their duties.

Serves as primary liaison between Advocate Providers, PHO Administration, Advocate Hospitals, the physicians practice and Advocate Health Partners Operations to facilitate service excellence and retain existing business dollars. Assesses operation of multiple internal and external APP users and ensures development and proper use of efficient and cost~effective processes. Identifies improvements and changes required by all customers, plans and implements process changes, and monitors progress on an ongoing basis.




What You Will Need:

  • Associate's degree or equivalent experience
  • 3~5 years of healthcare Managed Care and/or Insurance environment. Including experience in claims processing / adjudication, GE claims adjudication and knowledge of various reimbursement methodology, third party insurance administration, Medicare/Medicaid rules and regulations, guidelines and multiple reimbursement methodologies.
  • Basic understanding ICD9, ICD10, CPT/HCPC coding.
  • Must have demonstrated and sustained strong analysis and problem solving skills.
  • Demonstrated ability to identify and communicate issues/problems with previously processed claims and communicate root cause.
  • Must have demonstrated the ability to diagnosis system issues.
  • Outstanding communication and presentation skills
  • Ability to interpret contract language and reimbursement terms.
  • Ability to succeed in a changing environment and handle multiple responsibilities
  • Ability to work independently and prioritize assignments
  • Ability to problem solve and handle difficult calls/situations and maintain professionalism
  • Outstanding organizational skills
  • Experience with PC applications, word processing, spread sheets, GE.
  • Flexible hours including occasional weekends
  • Ability to work under pressure within deadlines and in stressful conditions
  • Ability to succeed in multi~faceted, fast paced environment with multiple priorities and applications
  • Self~motivated, highly organized, positive professional relationship skills, detailed with outstanding communication and presentation skills
  • Exceptional EXCEL knowledge a plus
  • Lead or Supervisory experience


About Advocate Health Care


Advocate Health Care, named among the nation’s Top 5 large health systems based on quality by Truven Analytics, is the largest health system in Illinois and one of the largest health care providers in the Midwest. Advocate operates more than 250 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, the state’s largest emergency and Level I trauma network, one of the area’s largest home health care companies, and the region’s largest medical group. Advocate Health Care has 4 teaching hospitals and is a not-for-profit, mission-based health system affiliated with the Evangelical Lutheran Church in America and the United Church of Christ.