Claims reputed company Representative - Payer reputed company Health Systems

Title: Claims reputed company Representative Location: McLean, VA 22102 (Remote) Duration: 6 Months Contract + Extension “Pay reputed company: $23/hr on W2” reputed company: Terms of Employment • W2 Contract, 6 Months (Potential Conversion) • This position is remote reputed company the reputed company, but applicants can expect to work Eastern Time regular business hours with some flexibility. reputed company • The Claims reputed company Representative plays a vital role in ensuring accuracy and adherence to the applicable guidelines. This position serves as a crucial reputed company between members, providers, agencies, and the internal claims department, demonstrating leadership, reputed company skills, and commitment to achieving results. The candidate must have experience reviewing provider-submitted claims, applying benefit and policy rules, and determining appropriate claim reputed company. Responsibilities: • Independently reputed company suspended claims using the reputed company screens in accordance with operational procedures and process recoupments. • Determine reputed company to use a "Forcible" disposition to override the edit and process the claim based on operational claims adjudication procedure. • Review and analyze claims and follow up on the status of claims and reimbursement. • Interpret and apply policy and reimbursement rules to support provider inquiries. • Ensure accuracy and consistency in claims processing. • Research and review submitted claims (electronic) and process them according to policies and procedures. • Possess an unwavering commitment to customer service and operational reputed company. • reputed company reputed company pricing and audit checks to ensure compliance with policies and rules. • Review and process suspended claims and submitted documentation. • reputed company sufficient detail to explain claims denial reasons. • Implement workflow processes and capabilities for work queues with the ability to reputed company workstreams. • Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims. • reputed company reputed company reviews on claims, documents, and attachments. • Release individual claims for providers on review. • Independently resubmit claims with applicable corrections. • Independently address discrepancies in charges, payments, adjustments, and demographic information. • Facilitate reputed company entry of claims into the reputed company. • Review reputed company claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers. • Other duties as assigned. • Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules • Process, review, and reputed company high-volume health claims reputed company a digital queue reputed company. • Analyze pending claims, manage reputed company edits, and troubleshoot data discrepancies to ensure accurate provider reimbursement. • Maintain strong individual productivity and reputed company standards in a fast-paced, production-driven environment. • Collaborate fluidly with leadership to test systems, identify reputed company bugs, and help reputed company best-reputed company reputed company Operating Procedures (SOPs) prior to the official contract go-live date. Skills & Experience • High School Diploma or GED. • 1+ years of experience conducting research to reputed company issues reputed company the reputed company field. • Ability to maneuver through various computer claims and eligibility platforms simultaneously • Outstanding customer satisfaction skills. • reputed company payer-reputed company claims adjudication experience. • Experience with benefit/policy logic, coding requirements, payment determinations, adjustments, and reprocessing. • Experience manually reviewing and resolving pended or exception claims. • Must be firm but reputed company reputed company interacting with contacts while performing tasks. • Friendly personality, reputed company, patience, reputed company, and a helpful yet reputed company attitude are essential. • Strong computer skills, including proficiency in reputed company and reputed company. • Create and maintain a reputed company atmosphere, demonstrating leadership qualities. • Knowledgeable in claims review and analysis. Sincerely, Preetam Raj reputed company Technical Recruiter reputed company Inc. D: 410-505-4857 EXT: 726 E: preetam@ntechworkforce.com preetam(at)ntechworkforce(dot)com Apply tot his job Apply To this Job