GuideWell Source
GuideWell Source
GuideWell Source GuideWell отбасының құрамына кіреді және медициналық қызмет көрсету, медициналық сақтандыру және консалтинг салаларында жұмыс істейді. Компания пациенттердің нәтижелерін жақсартуға және тұтынушылардың белсенді қатысуын нығайтуға арналған күтім көрсету үлгілерін қоса алғанда, денсаулық сақтау шешімдерін әзірлеп, нарыққа шығарады. Оның қызметтеріне штаттық және федералдық Medicare және Medicaid бағдарламалары үшін әкімшілік қолдау көрсету және талаптарды өңдеу де кіреді. Бұл денсаулық сақтау ұйымдарына сенімділік пен операциялық тиімділікке баса назар аудара отырып, күрделі үдерістерді басқаруға көмектеседі.

Part-Time Claims Examiner I - Texas Remote

GuideWell Source is seeking a part-time Claims Examiner I to process medical, dental, vision, and mental health claims for WebTPA. The role includes coverage adjudication, claims investigations, overpayment recovery, and appeal resolution.

Сипаттама

  • Process and adjudicate medical, dental, vision, and mental health claims
  • Research claims across varying levels of complexity as needed
  • Review insurance coverage and medical necessity under policy guidelines using clinical edit logic
  • Meet or exceed qualitative and quantitative production standards
  • Conduct claims investigations and negotiate settlements
  • Interpret medical records and respond to Department of Insurance complaints
  • Authorize payments to claimants and healthcare providers
  • Review and recover claim overpayments and correct financial histories
  • Track complaints and resolutions in designated systems
  • Resolve claims appeals
  • Research benefits and confirm accurate plan loading

Талаптар

  • At least two years of related professional experience
  • Experience examining or adjudicating healthcare claims with a computerized claims payment system
  • High school diploma or GED
  • Working knowledge of CPT and ICD-10 coding
  • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits
  • Sound judgment, strong decision-making, and analytical ability
  • Ability to learn quickly and manage multiple tasks
  • Ability to build positive working relationships with physicians, healthcare facilities, clients, and providers
  • Clear, concise written and verbal communication skills, including conflict management
  • Proficiency with Microsoft Windows, Word, Excel, and customized medical CPT coding programs
  • Experience reviewing multiple surgical procedures and establishing reasonable and customary fees
  • Accurate data entry and 10-key proficiency by touch or sight

Артықшылықтар

  • Equal opportunity employer focused on an inclusive workplace where employees can belong and perform at their best
  • Training runs Monday through Friday from 8:00 a.m. to 4:30 p.m. Central Time
  • Four weeks of training

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