Claims Specialist II Job at Tier4 Group

Claims Resolution Specialist II

Baptist Health is hiring a Claims Resolution Specialist II for our Physician Bil...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

High School Diploma/GED
1-2 years Revenue Cycle Operations Experience Required
Less than 1 year Billing Experience Required
Less than 1 year Medical Insurance Experience Required
Less than 1 year Reimbursement Experience Required
Less than 1 year Accounts Receivable Experience Required
Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required

Job Responsibility

Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
Follows-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims
Works all assigned accounts on worklist in order depending on balance and age
Identify and communicate trends in denials to leadership
Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
Communicates with various departments to resolve any outstanding issues with claim to resolve denials
Possesses up to date knowledge related to CPT codes, ICD/10 codes

Fulltime

New

Office Specialist II, Cardiology

As the Office Specialist II, you will provide business services for patients and...

Location

United States , Fernandina Beach

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

High School Diploma or GED Equivalent Required
One-Two Years Front Desk Experience Preferred
Experience Working in a Medical Office Preferred

Job Responsibility

Assisting patients as needed
Reviewing and following up on unpaid insurance claims
Processing mail on a daily basis
Working with insurance carriers and Baptist Primary Care Centers
Check in and check out
Assisting with referrals as needed
Scanning documents

What we offer

Up to a $1,000 Sign-On-Bonus Available

Fulltime

Physician Coding Specialist II

Under the direction of the Revenue Cycle Supervisor – Coding the Physician Codin...

Location

United States , Shaker Heights

Salary:

20.11 - 31.44 USD / Hour

University Hospitals

Expiration Date

Until further notice

Requirements

High School Equivalent / GED
2+ years Of medical billing experience
Billing experience in a multi-specialty group is a plus
Excellent interpersonal skills
Ability to recognize, evaluates, and solves problems
Strong verbal and written communication skills
Extensive knowledge of the claims development process
Basic knowledge of ICD-9 and CPT coding
Ability to handle a variety of tasks with speed, attention to detail, and accuracy
Computer literate

Job Responsibility

Analyzes outstanding insurance accounts
Initiates follow-up on identified accounts
Communicates with payors and internal departments
Researches and responds to telephone inquiries
Reviews and corrects coding edits and denials
May code ICD-10 from written documentation
May abstract CPT/HCPCS codes
May perform computer assisted coding functions
Maintains patient/physician confidentiality
Provides information and feedback to personnel

What we offer

Healthcare
Dental
Vision
Retirement plan options
Additional offerings

Fulltime

Inventory Specialist II - Project Based

This is a project-based employee role supporting the initial development phase o...

Location

United States , Mendon

Salary:

17.00 - 20.00 USD / Hour

Autonomous Solutions

Expiration Date

Until further notice

Requirements

High School Diploma Required
1 year of Shipping and Receiving or Inventory Experience (preferred)
Strong time management and organizational skills
Exceptional computer skills
Exceptional written and verbal communication skills
Experience with Export Documentation (preferred)

Job Responsibility

Assembles orders
Complete all required documentation for domestic shipments
Complete receiving duties for incoming shipments
Prepare goods for shipping
Track inbound and outbound shipments to ensure timely arrival
File claims for missing packages/damage
Reconcile reimbursements
Help pull parts as needed for production
Help with cycle counting and inventory management as needed
Assist in any and all other Purchasing tasks as assigned

Fulltime

Office Specialist II

Baptist Health is hiring an Office Specialist II at Baptist Metabolic Weight Los...

Location

United States of America , Ponte Vedra

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

High School Diploma or GED Equivalent Required
One-Two Years Front Desk Experience Preferred
Experience Working in a Medical Office Preferred

Job Responsibility

Assisting patients as needed
Reviewing and following up on unpaid insurance claims
Processing mail on a daily basis
Working with insurance carriers and Baptist Primary Care Centers
Check in and check out
Assisting with referrals as needed
Scanning documents

Fulltime

Care Management Specialist II

Established in 1997, L.A. Care Health Plan is an independent public agency creat...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses
Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping

Job Responsibility

Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice
contacting and interviewing members to conduct a baseline assessment, assess self-care ability, assess knowledge and adherence deficits
conducting comprehensive clinical assessments as indicated
developing a member centric plan of care. Maintains assigned care management caseload for with a focus on the most complex, highest-risk members particularly those with advanced chronic conditions, co-occurring mental and/or substance abuse and complex social issues (e.g. homelessness, domestic violence)
Collaborates with primary care physician and other treating professionals as appropriate. Authorizes initiation of care management services and specialized program services for members and specific populations, and develops interventions designed to meet member or population desired outcomes. Provides comprehensive education and resources to members about accessing services, in-network use, national guidelines for care, community resources, and self-management skills and strategies
Employs engagement techniques to build relationships with members and their authorized representatives. Encourages participants to participate in their health care decisions and assists member with researching treatment options in order to communicate effectively with providers and to make informed decisions
Notifies Care Coordinators and CHWs of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Performs field assessment and care coordination functions in community settings with members, such as at the L.A. Care Community Resource Centers, medical clinics, and member homes

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Appeals and Grievance Specialist II - HP Appeals Grievances

This position requires the ability to work independently researching and reviewi...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate Degree Preferred
Previous Appeals and Grievance experience with Managed Care Plans
Good typing and letter writing skills
Excellent written and oral communication skills
Excellent research and analytical skills
Basic computer knowledge
Excellent customer service skills
Ability to work well with diverse groups of individuals
Utilizes effective communication and conflict management skills

Job Responsibility

Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests
Review and respond to complaints, grievances and appeals within the stated time frame for each request
Ensure 95% compliance with the Center for Medicare and Medicaid Services (CMS) guidelines is met by adhering to all state and federal regulations
Analyze and resolve customer inquiries by adhering to CMS guidelines and CHRISTUS Health internal policies and procedures
Actively communicate with other associates to guarantee accurate and timely responses to inquiries involving internal/external customer needs
Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary
Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures

Fulltime

Appeals and Grievance Specialist II

This position requires the ability to work independently researching and reviewi...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Associate Degree Preferred
Previous Appeals and Grievance experience with Managed Care Plans
Good typing and letter writing skills
Excellent written and oral communication skills
Excellent research and analytical skills
Basic computer knowledge
Excellent customer service skills
Ability to work well with diverse groups of individuals
Utilizes effective communication and conflict management skills

Job Responsibility

Research and provide resolution to issues such as claim denials, member and provider complaints, and reconsideration and redetermination requests
Review and respond to complaints, grievances and appeals within the stated time frame for each request
Ensure 95% compliance with the Center for Medicare and Medicaid Services (CMS) guidelines is met by adhering to all state and federal regulations
Analyze and resolve customer inquiries by adhering to CMS guidelines and CHRISTUS Health internal policies and procedures
Actively communicate with other associates to guarantee accurate and timely responses to inquiries involving internal/external customer needs
Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary
Certify that providers and members are reimbursed accordingly using Medicare reimbursement policies and procedures

Fulltime

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Claims Specialist II

Job Description

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