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Medical Claims & Eligibility Coordinator
Title: Medical Claims & Eligibility Coordinator
Location: Nashville, TN - Hybrid
Duration: 12 Months – W2 Role
Position Summary
Responsible for supporting the administration of medical service payments, client eligibility processing, vendor coordination, and payment denials under the Ryan White Part B program. Ensures accurate documentation, compliance with program requirements, and timely processing of invoices and eligibility applications.
Key Responsibilities
Location: Nashville, TN - Hybrid
Duration: 12 Months – W2 Role
Position Summary
Responsible for supporting the administration of medical service payments, client eligibility processing, vendor coordination, and payment denials under the Ryan White Part B program. Ensures accurate documentation, compliance with program requirements, and timely processing of invoices and eligibility applications.
Key Responsibilities
- Review and process medical service invoices, verify client eligibility, and ensure compliance with payer-of-last-resort requirements.
- Enter invoices into PTBMIS to authorize payments and monitor payment processing status.
- Assist with payment denials, including vendor correspondence, tracking, and recoupment procedures.
- Maintain and distribute updated Ryan White Part B Fee Schedules.
- Assist with the annual Authorization to Vendor process and maintain related documentation.
- Review and process client eligibility applications through the Ryan White Eligibility System (RWES).
- Maintain accurate records and ensure compliance with program policies, procedures, and confidentiality requirements.
- Perform other related duties as assigned.