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Patient Resources Representative

2 months ago

Irvine, United States Tranzeal Incorporated Full time

Job Title: Sr. Patient Resources Representative

Location: Irvine, CA

Work Mode: Hybrid (1 Day Office/Week)


Looking for Spanish speakers. Schedule is 6:30AM PST – 3:00PM PST.


Essential Duties and Responsibilities:

  • Work with insurance payers to research and take appropriate actions to resolve claim denials, rejections, and underpayments on behalf of our patients’ accounts; Research and resolution include but are not limited to phone and email exchanges with insurance payer or our clinics, submit appeals, in addition to the utilization of payer web portals and navigating between several internal applications
  • Intake and make outbound calls with insurance carriers regarding patient claims
  • Uses critical thinking, problem-solving and analytical skills to determine the root cause and/or trends of our non-paid claims or underpayments from insurance payers and follow appropriate policy and procedure to remediate
  • Uses exceptional organization, written, and verbal communication skills to produce detailed documentation of research and actions taken on claims
  • Develop and maintain positive working relationships with clinical personnel, fellow teammates, and insurance representatives
  • Works well under pressure in a fast-paced environment and meets expectations of deadlines, and carries out assignments to completion while maintaining a positive attitude
  • Maintain confidentiality of all company and patient information by HIPAA regulations and our policies
  • Comfortability talking on the phone is a must


Qualifications:

Required:

o Highschool Diploma or equivalent

o Healthcare and medical collections/denial remediation experience

o Intermediate computer proficiency in Microsoft Office tools including Excel, PowerPoint and Outlook

Preferred:

o Associates or Bachelor's degree

o Demonstrated history of resolving challenging issues

o Ability to research and problem solve, using analytical and critical thinking skills

o Deeply built values of TEAM