Arkansas Blue Cross and Blue Shield este un licențiat independent al Blue Cross and Blue Shield Association și oferă asigurări de sănătate în toate cele 75 de comitate ale statului Arkansas. Oferta sa include acoperire pentru persoane fizice și familii, planuri Medicare și Medigap, asigurări stomatologice și oftalmologice, planuri de asigurare medicală pentru călătorii și acoperire de grup sponsorizată de angajatori.
Compania își sprijină, de asemenea, membrii prin portalul Blueprint, care reunește instrumente pentru gestionarea planurilor de sănătate, verificarea cererilor de despăgubire, găsirea furnizorilor de servicii medicale și estimarea costurilor tratamentului. Activitatea sa acoperă servicii de asigurări de sănătate, asistență pentru membri și administrarea digitală a planurilor de sănătate.
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.
Descriere
- 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.
Cerințe
- 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.