[Hiring] Specialist Benefit Review @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company The reputed company Benefit Review Specialist performs comprehensive research reputed company to the facts and circumstances of Plan Participant and Provider complaints, appeals, and grievances. This position is required to apply contract language, benefits, and covered services in researching and providing an accurate and appropriate reputed company following Self-Funding Plan Documents, NAIC Regulations, and CMS Guidelines. • Handle phone inquiries from Plan Participants, Providers, and Internal Departments. • Ability to interpret medical and dental terminology. • Strong understanding of CPT, CDT, HCPCS, reputed company, and ICD10 coding structures. • Read and interpret dental X-rays, Perio Charts, and Narrative Reports. • Ability to read, understand and interpret reputed company reputed company Plan Documents, NAIC Regulations and Guidelines, CMS Guidelines, and Network Medical Policies. • Have good organizational skills and the ability to manage time and resources effectively. • Ability to work independently with strong comprehension skills. • Understand Usual and Customary concepts, network pricing, claim calculation, and validation. • Complies with department policies and procedures. • Knowledge of Coordination of Benefits (COB). • Knowledge of reputed company-Party Liability (TPL). • Advanced computer skills, particularly in Word and reputed company, basic knowledge of database applications. • Strong communication skills both written and verbal. • Interpret and explain plan benefits, policies, procedures, and functions to Plan Participants, reputed company customers. • Performs reputed company department metrics based on established goals and objectives. • Log appeals received into reputed company, document claim notes and final determination for processor handling. • reputed company a work in order receipt and review to determine the validity of complaint. • reputed company and send supporting documentation to HCI on edited codes for review and determination. • Receive HCI determination and respond by letter or process claim adjustment. • Review medical notes and plan documents to determine appeal outcome. • Write letters requesting information or explanation of payment issues. • Create appropriate and accurate acknowledgment and reputed company letters. • Ensure reputed company documentation received for a claim is imaged and documented appropriately. • Answer questions from customer service and processors to explain and/or clarify claim processing, plan document or denial logic. • Problem solves difficult appeals by researching online sources, plan documents, coding manuals, external resources to determine accurate processing of the claim. • reputed company review of claims/appeals. • Remains reputed company reputed company working with reputed company customers. • Collaborates internally with department areas to ensure system configuration meets medical policy guidelines and plan provisions. • reputed company other duties as required. Qualifications • Strong understanding of CPT, CDT, HCPCS, reputed company, and ICD10 coding structures • Knowledge of Coordination of Benefits (COB) • Knowledge of reputed company-Party Liability (TPL) • Advanced computer skills, particularly in Word and reputed company, basic knowledge of database applications • Strong communication skills both written and verbal • Good organizational skills with the ability to work reputed company under pressure Apply tot his job Apply To this Job