Description & Requirements
This is a fast-paced, deadline-driven position. The team is looking for a self-starter and fast learner who is able to problem-solve and critically think through non-linear processes.
This position requires a schedule of 8:00am - 5:00pm EST Monday - Friday.
Essential Duties and Responsibilities:
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position
- Function as a Subject Matter Expert in one or more process areas.
- Analyze data submitted for Independent Medical Review.
- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.
- Create arbitration cases in the system.
- Send requests for information to providers and health plans.
- Close arbitration cases in the system.
- Analyze data received from providers and health plans.
- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
- Ability to manage multiple tasks efficiently and maintain accurate records.
- Excellent written and verbal communication skills to interact with healthcare providers and insurance companies.
- Ability to work across multiple platforms.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and healthcare billing systems.
- Ability to successfully work in a fast-paced, deadline-driven environment.
- High level of accuracy in data entry and document management.
- Ability to work independently as a part of a team remotely.
- Experience with Salesforce platform preferred.
- Understanding of healthcare billing, CPT codes, and the No Surprises Act preferred.
- Experience with healthcare appeals and/or grievances preferred.
- Experience with retroactive claim review highly preferred.
- Familiarity with insurance documentation, explanation of benefits, and/or claim forms highly preferred.
- Ability to commit to a schedule of 8:00am - 5:00pm EST Monday - Friday required.