Medical Claims Specialist
2 weeks ago
Title**:Claims Liaison**
Location**:REMOTE**:
- _can live anywhere in US as long as they can work AZ hours_
Duration**:6 months contract (Temp to hire)**
Target Start Date (based on successful onboarding completion)**:6/17/2024**
Shift**:Anytime between 7:00 AM - 5:00 PM MST - 8 hours/day**
Walk me through the day-to-day responsibilities of this the role and a description of the project:
- Audit check run and send claims to the claims department for corrections.
- Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
- Collaborate with the claims department to price pended claims correctly
- Document, track and resolve all plan providers’ claims projects
- Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
- Identify authorization issues and trends and research for potential configuration related work process changes
- Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
- Identify potential and documented eligibility issues and notify applicable departments to resolve
- Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
- Run claims reports regularly through provider information systems
- Research verbal and written providers’ claims inquiries as needed
- Experience with Researching and Analyzing healthcare claims
- Strong Excel-Intermediate and above exp required-pivot tables and v-looks are used frequently so they must have this
What previous job titles or background work well in this role?
- Claims, Medical billing,
**Required Skills/Experience/Education**:
- **3+ years of RECENT Claims & Medical Billing Experience in a Managed Care environment.**:
- **Strong Excel Skills - Intermediate and above experience required (pivot tables and v-look up)**:
- **Analytical Skills, Attention to detail, Strong Typing/Data Entry Skills 40 WPM, Strong Proficiency in Microsoft Office, experience with multiple screens, and Multitasking skills.**:
- High School Diploma or GED required.
**Job Type**: Contract
Pay: $25.00 per hour
Expected hours: No less than 40 per week
**Benefits**:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Weekends as needed
Work setting:
- Remote
**Experience**:
- Pivot tables: 3 years (required)
- Microsoft Excel: 3 years (required)
- Medical Claims: 3 years (required)
- Medical billing: 3 years (required)
Work Location: Remote
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