GuideWell Source GuideWell oilasining bir qismi bo‘lib, tibbiy xizmatlar ko‘rsatish, tibbiy sug‘urta va konsalting yo‘nalishlarida faoliyat yuritadi. Kompaniya bemorlar natijalarini yaxshilash va iste’molchilar ishtirokini kuchaytirishga mo‘ljallangan parvarish modellari, shuningdek, boshqa sog‘liqni saqlash yechimlarini ishlab chiqib, bozorga olib chiqadi. Uning xizmatlari shtat va federal Medicare hamda Medicaid dasturlari uchun ma’muriy ko‘mak va da’volarni qayta ishlashni ham o‘z ichiga oladi. Bu sog‘liqni saqlash tashkilotlariga ishonchlilik va operatsion mukammallikka e’tibor qaratgan holda murakkab jarayonlarni boshqarishda yordam beradi.
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.
Tavsif
- 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
Talablar
- 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
Imtiyozlar
- 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