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Medical Claims Processor (Must have medical claims exp.-Remote role)

Company: Jobot
Location: San Jose
Posted on: May 16, 2022

Job Description:

If you are a medical claims guru, I need you This Jobot Job is hosted by Dana Stark Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. A Bit About Us Our services target the $2.8 trillion in US healthcare spending using our healthcare transparency tools. Why join us? Working within our fast growing Healthcare Technology organization, you could become one of our ambitious Patient Advocates with a focus on Reference-Based Pricing (RBP). Job Details Working within our fast growing Healthcare Technology organization, you could become one of our ambitious Patient Advocates with a focus on Reference-Based Pricing (RBP). Our services target the $2.8 trillion in US healthcare spending using our healthcare transparency tools. Primary Purpose The Patient Advocate is responsible for handling member, client and provider inquiries (Balance Bills and appeals) based upon an assigned client base. This person is also responsible for addressing member calls related to balance billing situations, educating of the process and negotiations for closing out the balance bills. The Patient Advocate is experienced and highly skilled in working with facilities, providers through negotiations and helping guide patients related to balance billing claim issues . Core Responsibilities Manages facility, provider and member inquiries, appeals and balance billing; including correspondence. Reviews and resolves balance bills and appeals with providers; through negotiations. Identifies troubled facilities for potential direct contracting and redirection. Ensures clear documentation of events associated to a claim resolution. Provides updates and solicits required information from clients as needed. Keeps direct report informed of critical matters that impact responding timely to appeals/balance bills. Manages a daily running inventory of claims, prioritizing one---s work schedule accordingly. Addresses emails and incoming calls. Ensures member inquiries are addressed timely; including education. Participates in on-going process improvement to develop efficiencies that streamline the process and the Patient Advocacy Center. Assists in maintaining a clean, safe and unobstructed workplace environment. These duties are not exclusive and with consideration of your job requirements and other skills, this job description can be added to or taken away from at the discretion of your immediate supervisor. Qualifications Baccalaureate degree (BA/BS) from an accredited college or university preferred Experience in a medical healthcare claims role dealing with facilities, providers and members is Required Background in healthcare claims management environment including provider hospital billing, claims adjudication and administration or the ability to interpret benefit plans/Explanation of Benefits This role necessitates a proactive, self-starter Possesses exceptional multi-tasking and strong communication skills, both oral and written A high level of professionalism, organization and flexibility Excellent written, verbal, and interpersonal communication skills Excellent organizational skills demonstrating strong attention to detail Ability to manage high call volume Ability to multi-task effectively Should possess a moderate to high level of claim editing, coding, RVU and CMS-based pricing knowledge with an emphasis in researching solutions for the above items as needed Bilingual preferred PC literate, including Microsoft Office products and web-based applications Regular, timely attendance Interested in hearing more? Easy Apply now by clicking the "Apply" button.

Keywords: Jobot, San Jose , Medical Claims Processor (Must have medical claims exp.-Remote role), Healthcare , San Jose, California

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