Claims Specialist - Holista - Remote 1st shift!

Important things YOU should know:

• Eligibility: Candidate must be a resident of one of the following states to qualify for this opportunity: AZ, FL, MO, NV, TX, WA and WI
• 100% Remote: This position is open to work remotely in any of the states listed above

• Schedule: 8:00am - 4:30pm CST Monday - Friday

What will YOU be doing for us? Will have the opportunity to research and resolve all claims and authorizations exceptions using internal resources. Provide communication to providers as necessary regarding the status of a claim or authorization. Follow up with providers on all financial implications of reprocessed claims or authorizations.

What will YOU be working on every day?

• Transport all claims entered by processors from image software to proprietary software for review.

• Utilizing knowledge of system, research current queues of work to find claims requiring further research and correction.

• Research and resolve any claim and authorization issues to determine best resolution.

• Work with internal departments to resolve issues involving authorization or claim handling.

• Recoup any overpayments to providers resulting from changes to a claim or authorization processing by posting to the provider account.

• Log all claims and authorizations that cannot be resolved and send rejection letters to providers.

• Using knowledge of authorizations, hold certain payments pending the outcome of client review.

• Adjudicate claims and send for payments ensuring that all proper documentation is attached.

• Complete daily audit of claims entered by Claim Intake representative.

Additional Responsibilities:

• Take any incoming calls from providers or members regarding authorizations, benefits, or claim status.

• Provide back up to Accounts Receivable Assistant or Authorization Representative as needed.

• Develop and/or communicate methods to improve productivity and efficiency.

• Assist with gathering data for client audits.

• Contribute to the team effort by accomplishing additional responsibilities as needed.

• Assist with training of new staff members.

What qualifications do YOU need to have to be a GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates

  • High school diploma or equivalent

• Required Level of Experience

  • 1+ year(s) of general administrative or office experience.

• Required Knowledge, Skills, and Abilities

  • Proficient in MS Office Word/Excel/Outlook.

  • Demonstrated Analytical and critical thinking skills.

  • Ability to prioritize and organize multiple tasks.

  • Ability to remain organized with multiple interruptions.

  • Ability to successfully communicate with clients.

What qualifications do YOU need to have to be a GREAT candidate?

• Preferred Level of Education, Licenses, and/or Certificates

  • Post secondary education in a related field.

• Preferred Level of Experience

  • 3+ year(s) working with medical insurance/claim process.

  • Previous experience working in a remote environment.

• Preferred Knowledge, Skills, and Abilities

  • Knowledge of health care and/or PT, OT, ST terminology, coding, and operations.