Fund Control Specialist at Wellpath

• Make a difference every day in the lives of the underserved
• Join a mission driven organization with a people first culture
• Excellent career growth opportunities
  
  

Join Us And Find a Career That Supports

• Caring for overlooked, underserved, and vulnerable patients
• Diversity, equity, inclusion, and belonging
• Autonomy in a warm team environment
• Growth and training
  
  

Perks And Benefits

In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including:

• DailyPay, receive your money as you earn it!
• Tuition Assistance and dependent Scholarships
• Employee Assistance Program (EAP) including free counseling and health coaching
• Company paid life insurance
• Tax free Health Spending Accounts (HSA)
• Wellness program featuring fitness memberships and product discounts
• Preferred banking partnership and discounted rates for home and auto loans
• Eligibility for perks and benefits varies based on employee type and length of service.
  
  

Why Us

Now is your moment to make a difference in the lives of the underserved.

If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time.

Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan.

We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support.

How you make a difference

The Fund Control Specialist performs pre- and post-payment audits of external claims; ensures that the company rigorously manages claims for external services; ensures that claims are paid according to contracted rates, for approved services, and are otherwise appropriate and correct; reviews and responds to claims submitted on appeal.

Key Responsibilities

• Complete accurate and timely audits of out-of-facility claims, confirming eligibility, claim amounts, and related events.
• Maintain financial and administrative controls to support proper claim payments while ensuring compliance with standards, audit criteria, contracts, and policies.
• Perform claims appeals and high-dollar reviews, including contract compliance checks and written responses.
• Review and validate the use of current provider contracts, fee tables, reference data, and contract batches, and provide quality assurance before submission.
• Track and report audit findings, identify issues and solutions, oversee the FBOP inbox, and provide estimated procedure costs when requested.
  
  

Qualifications & Requirements

Education

• Bachelor’s degree or equivalent experience.
  
  

Experience

• Minimum of five years of experience in claims processing and claims audit functions.
  
  

We are an Equal Employment Opportunity Employer

We are committed to fostering, cultivating, and preserving a culture of uniqueness.

We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees.

We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles.

Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description.

We are an Affirmative Action Employer in accordance with applicable state and local laws.