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.
Remote Claims Examiner I – Texas
Process and adjudicate healthcare claims for medical, dental, vision, and mental health services. The role also investigates overpayments, appeals, benefits, and coverage for WebTPA, a healthcare third-party administrator.
Descriere
- Process and adjudicate claims for medical, dental, vision, and mental health services
- Research claims with varying levels of complexity
- Review and process insurance claims, using clinical edit logic to verify medical necessity and policy coverage
- Meet or exceed quality and productivity standards
- Conduct claims investigations
- Negotiate settlements
- Interpret medical records
- Respond to Department of Insurance complaints
- Authorize payments to claimants and providers
- Review and recover claim overpayments
- Correct financial histories for patients and service providers
- Track complaints and resolutions in designated systems
- Resolve claims appeals
- Research benefit details
- Verify that plans are loaded correctly
Cerințe
- At least two years of related work experience
- Healthcare claims examination or adjudication experience using a computerized claims payment system
- High school diploma or GED
- Knowledge of CPT and ICD-10 coding
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits
- Demonstrated judgment and decision-making skills
- Ability to analyze information, learn quickly, and handle multiple tasks
- Ability to maintain positive working relationships with physicians, healthcare facilities, clients, and providers
- Clear, concise written and verbal communication skills, including the ability to manage conflict
- Proficiency with Microsoft Windows, Word, Excel, and customized medical CPT coding programs
- Experience reviewing multiple surgical procedures and establishing reasonable and customary fees
- Data entry and 10-key skills by touch or sight
Beneficii
- Medical, dental, vision, life, and global travel health insurance
- Life insurance
- Short- and long-term disability programs
- Flexible schedules available after training
- Potential future work-from-home options
- Leave programs for personal circumstances
- Retirement Savings Plan with employer contributions and matching
- Paid time off
- Volunteer time off
- 11 holidays
- Additional voluntary benefits
- Comprehensive wellness program