Care Navigator - Billing Certificate Required
About The Position
Care Navigator We are excited to announce that currently we are looking for a 100% remote (work from home—WFH) contact Care Navigator to join our team. In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The Care Navigator is primarily responsible for receiving medical claims from HCPs or patients and vetting the claim against program specific business rules to determine if the claim should be paid or rejected. Job Responsibilities: Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected Exceptional organizational skills are required May provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary Schedule: Ability to work 40 hours per week under moderate supervision
Requirements
- High School Diploma or equivalent
- Experience in claim processing required
- Required to have active Medical Billing Certification with CEUs up to date or must be willing to get certification
- Medical Billing experience required
- Ability to interpret Explanation of Benefits (EOB)
- HIPPA trained
- Must reside in country where the job is posted.
Nice To Haves
- Infusion or Hospital Billing Experience Preferred
- Customer Service Experience preferred
- Pharmacy Technician experience preferred
Responsibilities
- Receiving medical claims from HCPs or patients
- Ensuring the adequate supporting documentation has been provided
- Interpreting the EOB/CMS1500
- Vetting the claim against program specific business rules
- Determining if the claim should be paid or rejected
- Provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center
- Recognize operational challenges and suggest recommendations to management, as necessary
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
