GuideWell Source je del skupine GuideWell Family in deluje na področjih zagotavljanja zdravstvene oskrbe, zdravstvenega zavarovanja in svetovanja. Podjetje razvija zdravstvene rešitve in jih uvaja na trg, vključno z modeli oskrbe, zasnovanimi za izboljšanje izidov zdravljenja pacientov in krepitev vključenosti uporabnikov. Njegove storitve vključujejo tudi administrativno podporo in obdelavo zahtevkov za državne in zvezne programa Medicare in Medicaid, s čimer zdravstvenim organizacijam pomaga upravljati zapletene postopke s poudarkom na zanesljivosti in operativni odličnosti.
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.
Opis
- 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
Zahteve
- 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
Ugodnosti
- 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