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GuideWell Source
GuideWell Source
1.001 – 5.000 Angajați
Sponsor pentru viza H1BAsigurare de sănătateAsistență medicalăConsultanță
GuideWell Source face parte din familia GuideWell și activează în domeniile furnizării de servicii medicale, asigurărilor de sănătate și consultanței. Compania dezvoltă și introduce pe piață soluții de sănătate, inclusiv modele de îngrijire concepute pentru îmbunătățirea rezultatelor pacienților și consolidarea implicării consumatorilor. Serviciile sale includ, de asemenea, sprijin administrativ și procesarea solicitărilor pentru programele Medicare și Medicaid statale și federale, ajutând organizațiile din domeniul sănătății să gestioneze operațiuni complexe, cu accent pe fiabilitate și excelență operațională.
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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.

USStatele Unite ale AmericiiTXTexasRemoteNormă parțialăJuniorNivel mediuNu este necesară o diplomăLimbă Obligatorie: englezăSpecialist în daune

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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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