Arkansas Blue Cross and Blue Shield ir neatkarīgs Blue Cross and Blue Shield Association licences turētājs, kas nodrošina veselības apdrošināšanu visos 75 Arkanzasas apgabalos. Uzņēmuma piedāvājumā ietilpst individuālā un ģimenes apdrošināšana, Medicare un Medigap plāni, zobārstniecības un redzes apdrošināšana, ceļojumu veselības plāni, kā arī darba devēju nodrošināta grupas apdrošināšana.
Uzņēmums atbalsta savus biedrus arī ar Blueprint Portal, kurā apkopoti rīki veselības plānu pārvaldībai, atlīdzību pieteikumu pārskatīšanai, veselības aprūpes pakalpojumu sniedzēju atrašanai un ārstēšanas izmaksu aprēķināšanai. Tā darbība aptver veselības apdrošināšanas pakalpojumus, biedru atbalstu un veselības plānu digitālo administrēšanu.
Remote Medical Claims Specialist
Process medical claims that require manual review for Arkansas Blue Cross and Blue Shield, investigating benefits, eligibility, coding, audits, and processing issues. This full-time remote role is based in the United States.
Apraksts
- Resolve medical claims that the system does not automatically adjudicate, meeting quality, accuracy, and productivity standards.
- Investigate claims and gather the information needed to complete them.
- Enter information into the claims system.
- Review and interpret contract benefits.
- Resolve claim edits and audit findings.
- Determine eligibility for benefits.
- Research processing issues using internal systems and manuals.
- Refer claims to other departments when needed.
- Consult internal colleagues and medical providers.
- Prepare correspondence and forms to request missing information.
- Complete initial instruction, on-the-job training, and ongoing education.
- Use relevant computer systems and screens to process claims accurately.
- Keep up with changes to processing procedures, benefits, and systems.
- Meet corporate and national MTM standards while maintaining departmental quality and productivity.
- Consult corporate and professional reference materials, including the company processing manual and ICD, CPT, and HCPS codebooks.
- Carry out other assigned duties.
Prasības
- High school diploma or equivalent.
- At least 48 semester hours of college coursework or equivalent certification focused on anatomy, medical terminology, math, biology, or a related field; alternatively, at least one year of related office experience in claims processing, health insurance, or a medical office.
- Pass the company Claims Assessment proficiency test.
- Oral and written communication skills.
- Strong interpersonal skills.
- Sound judgment.
- Decision-making ability.
- Attention to detail.
- Ability to work as part of a team.
- Dependability.
- Protect the security and confidentiality of records and information.
- Follow segregation of duties guidelines in the Administrative Manual.