We have other current jobs related to this field that you can find below
-
HealthLock Medical Claims Auditor
3 months ago
Franklin, United States inAssist Full timeJob DescriptionJob DescriptionHealthLock Medical Claims Auditor / Advocate II HealthLock is a leading provider of Healthcare Management Solutions, utilizing our Medical Claims Auditors / Advocates, comprehensive analytics, and tailored technology solutions. Driven by our commitment to our clients, we take pride in delivering exceptional service. The...
-
Sr. Business Analyst
1 month ago
Franklin, United States inAssist Full timeJob DescriptionJob DescriptionSr. Business Analyst / Project ManagerHealthLockFranklin, TN 37064Qualifications• US work authorization (Required)• Business Analyst / Project management: 5 years (Preferred)• PMP Certified (Preferred)Full Job DescriptionHealthLock / inAssist Health Management Solutions is one of the nation's leading providers of...
-
Claims Assistant
2 months ago
Franklin, United States CorVel Corporation Full timeCorVel is hiring a part-time, remote Claims Assistant for the Nashville, TN office. The Claims Assistant will assist and support the claims staff in the set-up and administration of workers’ compensation claims/case management and other tasks depending on the specific needs of the customers. This position is temporary. ESSENTIAL JOB DUTIES: Sets...
-
Corporate - Claims Coordinator
1 month ago
Franklin, United States Acadia Healthcare Full timeOverview: PURPOSE STATEMENT: Hybrid M-W in office 2 days remote Under the supervision of the Director Workers Compensation Claims, this role will provide assistance in all aspects within the Claims Department, including handling related work tasks, as well as general office support, as required. Primary responsibilities will be to assist in managing workers'...
-
Claims Processing Coordinator
1 day ago
Franklin, Tennessee, United States National Seating & Mobility Full timeCompany Overview: At National Seating & Mobility, we offer a unique opportunity to make a significant difference in the lives of our clients, promoting their independence and self-sufficiency. Our workforce is made up of dedicated professionals who are committed to delivering exceptional care tailored to each client's specific needs. We emphasize individual...
-
LTC Claims Pending Specialist
1 month ago
Franklin, United States Northwestern Mutual Full timeAt Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference. Primary Duties and responsibilities Determines the applicability of benefits claimed by interpreting contract provisions, and state regulations, and uses claim knowledge in interpreting and analyzing...
-
LTC Claims Pending Specialist
4 weeks ago
Franklin, United States Northwestern Mutual Full timeAt Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference. Primary Duties and responsibilities Determines the applicability of benefits claimed by interpreting contract provisions, and state regulations, and uses claim knowledge in interpreting and analyzing...
-
LTC Claims Pending Specialist
1 month ago
Franklin, United States Northwestern Mutual Full timeAt Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference. Primary Duties and responsibilities Determines the applicability of benefits claimed by interpreting contract provisions, and state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim...
-
LTC Claims Pending Specialist
1 month ago
Franklin, WI, United States Northwestern Mutual Full timeAt Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference. Primary Duties and responsibilities Determines the applicability of benefits claimed by interpreting contract provisions, and state regulations, and uses claim knowledge in interpreting and analyzing...
-
Medical Billing Specialist
1 month ago
Franklin, United States Inception Fertility Corporate Services Full timeJob DescriptionJob DescriptionThe Medical Billing Specialist is responsible for the timely and accurate submission of insurance claims, reviewing and updating denied claims for resubmission and performing reconciliations to ensure timely billing for services provided. The Medical Billing Specialist collaborates with patients, revenue cycle counterparts and...
-
Medical Coding Specialist
4 days ago
Franklin, United States Inception Fertility Corporate Services Full timeJob DescriptionJob DescriptionWe are seeking a skilled Medical Coding Specialist to manage the initial submission of insurance claims and self-pay posting in line with established procedures. The ideal candidate will also address coding-related denials and handle the resubmission of corrected claims. Responsibilities encompass a broad range of coding tasks,...
-
Revenue Specialist, First Party Billing, MVA
4 weeks ago
Franklin, United States EnableComp Full timeRecognized as a 2024 Top Workplace by the Tennessean , EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Night Auditor
1 month ago
Franklin, United States Drury Hotels Full timePAYS UP TO $18.38 AN HOUR Property Location: 3320 Village Drive - Franklin, Ohio 45005 You belong at Drury Hotels. Getting a job is just the beginning. Finding a place where you belong is what truly matters. Who you are and what you do makes a difference at Drury Hotels. There's a place for you here today and tomorrow. WHAT YOU CAN EXPECT FROM US So. Much....
-
Revenue Specialist, First Party Billing, MVA
3 weeks ago
Franklin, United States enablecomp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Specialist, Commercial Billing, MVA
4 weeks ago
Franklin, United States EnableComp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Specialist, Commercial Billing, MVA
4 weeks ago
Franklin, United States enablecomp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Specialist, Third Party Billing, MVA
4 weeks ago
Franklin, United States EnableComp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Specialist, Third Party Billing, MVA
4 weeks ago
Franklin, United States enablecomp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Specialist, Third Party Billing, MVA
3 weeks ago
Franklin, United States EnableComp Full timeRecognized as a 2024 Top Workplace by the Tennessean, EnableComp is the leading source of revenue cycle management solutions for complex claims in the US. We proudly partner with well over 1000+ hospitals across the US to help them maximize their revenue from complex claims. Our Mission We partner with healthcare providers to maximize reimbursement from...
-
Revenue Cycle Specialist
3 weeks ago
Franklin, United States Acadia Healthcare Full timeOverview: Now Hiring: Revenue Cycle Specialist Franklin, TN - Hybrid Our Passion: We exist to Lead Care With Light. We need passionate, talented people working together who share our desire to provide the best quality care to our patients and lead the fight against the opioid epidemic. We are prepared to treat the entire disease, not just a piece of it. ...
![inAssist](https://media.trabajo.org/img/noimg.jpg)
HealthLock Medical Claims Auditor
2 months ago
HealthLock Medical Claims Auditor / Advocate II
HealthLock is a leading provider of Healthcare Management Solutions, utilizing our Medical Claims Auditors / Advocates, comprehensive analytics, and tailored technology solutions. Driven by our commitment to our clients, we take pride in delivering exceptional service.
The Medical Claims Auditor / Advocate II reviews complex healthcare claims to identify discrepancies, verify pricing, confirm prior authorizations and benefits in an effort to reduce members’ out of pocket healthcare costs. You’ll need to be comfortable navigating multiple computer systems to find critical information as well as maximize your knowledge of the healthcare system. Critical thinking and attention to detail is crucial for accurate and timely case resolution.
Job Role:
Review patient medical bills, correspondence, and Explanation of Benefits (EOBs) for errors.
Liaise with insurance carriers and providers to address identified issues (e.g., appeal incorrectly denied claims, rectify billing errors, negotiate with providers regarding inappropriate billing).
Communicate with providers and carriers via phone and email, ensuring prompt and professional responses, and going above and beyond to address concerns, making medical bills and paperwork a worry-free experience.
Identify problems and inconsistencies using management reports and critical thinking skills.
Utilize expertise and take initiative to resolve claims/billing issues.
Review EOBs and examine claims for appropriate coding of CPT and ICD-9 and -10 codes and modifiers against charges that are billed.
Apply appropriate processes and procedures for medical claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).
Review and apply member benefit plans and provider contracts, pricing, CMS rate letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim.
Job Requirements:
Background in medical billing or insurance claims administration (Medical Billing, Coding and Collections Specialists, and/or Health Insurance Claims Administrators strongly preferred).
3-5+ years’ experience in Medical Billing and Coding.
Strong critical thinking and problem-solving skills.
Proficiency in Explanation of Benefits (EOB) knowledge.
Strong interpersonal skills.
Self-motivated and reliable.
Proven exceptional ability to organize, prioritize and communicate effectively with carriers and providers.
Experience with Out of Network (OON) Benefits is advantageous.
Understanding of general Coordination of Benefit Rules, Benefit Analysis.
Knowledge of eligibility requirements and insurance enrollment.
Experience in overturning claim denials, from simple solutions like coding correction to more complex appeals and grievances.
Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claim errors/issues, using clear, simple language to ensure understanding.
Excellent time-management and deadline management skills.
Ability to multitask with a sense of urgency.
Knowledge of CPT/ICD-9 and -10 required. Medical Billing and/or Coding Certificate a plus.
Website navigation proficiency of carrier web portals for resolution and/or claim processing.
Experience in investigating and researching appeals and drug manufacturer websites for copay assistance.
Support implementation of updates to the current procedures and participate in new system updates and training.
Excellent organizational and scheduling abilities.
Proficiency with Microsoft Office Suite (Outlook, Word, Excel etc.)
Benefits you will enjoy when you join our team:
Extensive paid training.
Supportive team environment and advancement opportunities.
Comprehensive benefits, including medical, dental, vision, 401K, and life insurance.
Generous PTO and paid Holidays.
Join a rapidly growing and dynamic healthcare company
Company DescriptionBe a part of a rapidly growing and dynamic healthcare company inAssist Healthcare Management Solutions / HealthLock is a fast-growing company that occupies a unique niche in the market of healthcare claims processing by representing the patient, our client, in negotiating their medical bills. Our proprietary application software and Medical Claims Auditors / Personal Healthcare Advocates check every claim for our users to determine where the savings can be found - in denials, negotiating out of network claims, or coordination of benefits. We take the pain out of healthcare and return savings to consumers. Driven by our commitment to our clients, we pride ourselves in our ability to ensure our clients receive the best service possible.Company DescriptionBe a part of a rapidly growing and dynamic healthcare company inAssist Healthcare Management Solutions / HealthLock is a fast-growing company that occupies a unique niche in the market of healthcare claims processing by representing the patient, our client, in negotiating their medical bills. Our proprietary application software and Medical Claims Auditors / Personal Healthcare Advocates check every claim for our users to determine where the savings can be found - in denials, negotiating out of network claims, or coordination of benefits. We take the pain out of healthcare and return savings to consumers. Driven by our commitment to our clients, we pride ourselves in our ability to ensure our clients receive the best service possible.