Network Service Claims Specialist

WHAT’S THE FORMAL TITLE?

Network Service Claims Specialist

 

WHAT’S THE REAL TITLE?

Life Saver

 

WHAT’S YOUR MOTTO?

“Be awesome to everyone!”
 

WHY IS THIS ROLE CRITICAL?

You will be working directly with customers and working in our pricing system. Because of you, questions will be unanswered and claims will be paid….  Providers will be happy… OUR NETWORKS WILL THRIVE! This position is the lifeblood of Imagine Health.

 

WHAT IS A DAY IN THE LIFE?

It’s a little like playing Bob Barker on the Price is Right and having Sherlock Holmes as your first contestant. You will be responsible for serving external customers by pricing claims accurately and timely based on terms outlined in physician and hospital contracts. You will understand medical language, including the various healthcare data types and the basics of health information technology. You will also manage the administration/client relationship as it deals with access to pricing system and training.

 

OK, HOW ABOUT SOME SPECIFIC RESPONSIBILITIES? 

  • Interprets and processes complex claims in accordance with complex contractual agreements with physicians and hospitals.
  • Processes paper claims and electronic work queues, including complex HCFA 1500 and UB92, in accordance with company policies and procedures.
  • Investigates, analyzes and resolves outstanding issues to achieve customer satisfaction.
  • Acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making.
  • Uses good judgment and logic in evaluating and resolving difficult claims issues.
  • Will interface with customers via telephone to respond to routine inquiries and resolve concerns on an as-needed basis.
  • Maintains and manages Administrator/Client relationships and data related to claims pricing access
  • Trains Administrator/Clients on claims pricing in accordance with established policies and procedures
  • Performs other duties as required.

 

WHAT TYPE OF THINGS HELP ME THRIVE IN THIS ROLE? 

  • Associate’s Degree or equivalent experience.
  • 2+ years of experience working in a healthcare support environment is preferred.
  • Solid knowledge of RBRVS, DRG, CPT-4, ICD-9, ICD-10 and other standard medical coding reimbursement methodologies.
  • Advanced skill and proficiency using Microsoft Word, Excel, and Access.   MySQL experience is a bonus.
  • Medical terminology familiarity preferred. 
  • Ability to plan, organize and prioritize multiple projects to independently meet deadlines and complete tasks in an accurate manner.
  • Highly self-motivated and accountable
  • Excellent verbal and written communication skills.
  • Excellent organizational and interpersonal skills.
  • Understanding of concepts related to Healthcare Provider Networks

 

Does this sound like you?  Send us a resume:  careers@imaginehealth.com

Rick AbbottComment