Claims Resolution Representative Hybrid Warrick, RI

Gainwell Technologies LLC•Warwick, RI

1d•$30,500 - $43,500•Hybrid

About The Position

Perform routine but moderately complex tasks that are related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalates only the most complex issues to immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections and data entry. Performs other duties as assigned. Involved in the training of new employees and may take the lead in areas of expertise.

Requirements

Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education.
Healthcare, insurance, or third-party billing experience helpful
Self-motivated with excellent time management and organizational skills; ability to work independently.
Experience with Microsoft Outlook, Word, and proficiency with Excel
Ability to interpret healthcare policy, laws, and regulations.

Responsibilities

Resolve suspended medical claims utilizing Medical Assistance Policy.
Entry and/or approval of medical Prior Authorizations.
Entry and maintenance of third-party insurance information to facilitate coordination of benefits and benefit recovery.
Identification of accident-related claims.
Research, entry, and maintenance of HCPC and CPT codes; Entry of nursing home, hospital, federally qualified health centers and ambulatory surgical center rates.