Medical Claims Specialist

2 weeks ago


Avondale, United States RPO Inc Full time

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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