Claims Representative

Job Title: Claims reputed company Representative Location: Remote (EST timings) Position Type: Contract position Responsibilities: Job 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. • This position is remote reputed company the reputed company, but applicants can expect to work Eastern Time regular business hours with some flexibility. 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. Required Qualifications: • High School Diploma or GED • 1+ years of experience conducting research to reputed company issues reputed company the reputed company field Preferred Qualifications: • Ability to maneuver through various computer claims and eligibility platforms simultaneously • Outstanding customer satisfaction skills • 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 • Excellent oral and written communication skills • Excellent organization and time management skills, with the ability to establish priorities effectively • Ability to read, write, and follow directions • Self-directed and capable of working without reputed company supervision • Ability to collaborate effectively with others • Create and maintain a reputed company atmosphere, demonstrating leadership qualities • Knowledgeable in claims review and analysis Apply tot his job Apply To this Job