Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield Association की एक स्वतंत्र लाइसेंसधारी संस्था है, जो Arkansas के सभी 75 काउंटियों में स्वास्थ्य बीमा प्रदान करती है। इसके विकल्पों में व्यक्तिगत और पारिवारिक कवरेज, Medicare और Medigap योजनाएँ, दंत और दृष्टि बीमा, यात्रा स्वास्थ्य योजनाएँ और नियोक्ता-प्रायोजित समूह कवरेज शामिल हैं।
कंपनी Blueprint Portal के माध्यम से सदस्यों की सहायता भी करती है। यह पोर्टल स्वास्थ्य योजनाओं के प्रबंधन, दावों की समीक्षा, स्वास्थ्य सेवा प्रदाताओं को खोजने और उपचार की अनुमानित लागत जानने के लिए विभिन्न उपकरण एक जगह उपलब्ध कराता है। इसका कार्य स्वास्थ्य बीमा सेवाओं, सदस्य सहायता और डिजिटल स्वास्थ्य-योजना प्रशासन तक फैला हुआ है।
Remote Claims Specialist at Arkansas Blue Cross and Blue Shield
Process and resolve medical claims that require manual adjudication for Arkansas Blue Cross and Blue Shield. Investigate processing issues, interpret benefits, verify eligibility, and maintain accurate claim decisions.
विवरण
- Manually resolve medical claims that the automated processing system cannot adjudicate
- Investigate claim issues and communicate with relevant parties to collect missing information
- Record claim details accurately in the claims processing system
- Interpret contract provisions and applicable benefits
- Resolve claims edits and audit findings
- Assess whether services and claims meet benefit eligibility requirements
- Research processing problems using system resources and official manuals
- Refer claims to the appropriate internal teams
- Coordinate with internal employees and medical providers
- Prepare and issue claim-related correspondence
- Complete information-request forms as needed
- Participate in initial training, on-the-job instruction, and continuing education
- Use applicable computer systems and screens to process claims accurately
- Keep current with procedural, benefit, and system changes
- Meet corporate and national MTM productivity and quality standards
- Use corporate and professional reference materials, including processing manuals and ICD, CPT, and HCPCS codebooks
- Handle additional duties as assigned
आवश्यकताएँ
- High school diploma or equivalent
- At least two years of college coursework, totaling 48 semester hours, or equivalent certification focused on anatomy, medical terminology, mathematics, biology, or a related discipline; alternatively, at least one year of related office experience in claims processing, health insurance, or a medical office
- Successful completion of the company Claims Assessment proficiency test
- Effective oral and written communication
- Strong interpersonal abilities
- Sound professional judgment
- Effective decision-making
- Careful attention to detail
- Ability to work collaboratively
- Reliable and dependable work habits
- Ability to protect the security and confidentiality of records and information
- Compliance with segregation-of-duties requirements in the Administrative Manual