Determine medical necessity and appropriateness. Provide clinical expertise for pre-service reviews. Consult and lend clinical expertise to colleagues. Must meet the following requirements for consideration: Ability to travel up to 10% Minimum of Bachelor's degree.
A healthcare company has a current position open for a Telecommute Medical Claims Recovery Specialist. Candidates will be responsible for the following: Researching local billing and reimbursement policies, client reimbursement practices.
Developing creative solutions for appeals and exceptions to meet customer needs. Determining whether to accept, modify, or decline a risk through evaluation of an individual's medical history or physical condition. Evaluating and underwriting life insurance applications. Required Skills:
Creating and managing of project plans with internal cross-functional teams. Required Skills: Bachelor’s degree required. 5+ years in the healthcare industry working with medical claims and production support. Must have strong project management, communication and time management skills.
A healthcare company has an open position for a Telecommute Senior Medical Stop Loss Underwriter. Must be able to: Renew accounts and write new business at profitable levels. Achieve overall business targets or assigned volume of new applications.
Evaluate and process cancer, supplemental medical and/or routine disability claims. Obtain and maintain call flow certifications in accordance with department performance metrics. Ensure that claims are processed consistently and properly. Applicants must meet the following qualifications:
1-2 years of Bodily Injury, Senior Bodily Injury or Litigation Handling experience. Ability to make sound decisions while using good judgment in evaluating claims. Ability to review and interpret complex and detailed documents such as contracts, medical reports, etc.
Must be able to: Call to obtain insurance authorizations for medical procedures. Analyze the patient's clinical record to find the information needed. Must meet the following requirements for consideration: Ability to work within an EMR - specific training provided, but experience needed.
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business. Excellent oral and written communication, including presentation skills.
Bachelor's degree with 1-2 years of experience with RxClaim benefit set up. In lieu of degree, 4 years of industry experience with 1-2 years of required experience with RxClaim benefit setup. Experience with third party prescription/medical payment and/or claims adjudication system required.