Account Manager, Commerce
Sovrn
Medical Claims Specialist
Rising Medical Solutions
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida, Wisconsin
Visit company websiteSalary
💰 $24 - $28 per hour
Job Level
JuniorMid-Level
About the role
- Maintain ongoing knowledge of program requirements
- Analyze and process claims for accuracy, eligibility, and benefits coverage
- Retain and strengthen relationships with clients and members
- Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
- Correspond to verify if the amounts are related to the claim
- Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
- Adhere to quality assurance objectives and goals
- Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services
- Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
- Keep management updated on activities, issues and developments
- Document all claims decisions and communications with members in the system accurately and timely
- Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
- Perform special projects as assigned by management
- Reports to: Program Manager
Requirements
- High school diploma required
- Associate’s or Bachelor’s degree preferred
- CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification preferred
- 2-4 years of insurance or healthcare experience, preferably in claims or medical billing-related position(s)
- Knowledge of Group Health Insurance, Workers' Compensation, No-Fault, and/or Liability industry
- Strong knowledge of medical terminology, CPT and ICD coding, and healthcare billing practices
- Well-developed time-management, organization, and prioritization skills
- Excellent analytical skills
- Customer-service orientation
- Excellent oral and written communication skills
- Knowledge of medical billing procedures
- Ability to gather data, compile information, and prepare summary reports
- Strong interpersonal and conflict resolution skills
- Ability to work independently and as part of a team in a fast-paced, multi-faceted environment
- Demonstrated persistence and attention to detail
- Physical/Mental demands: remaining in a seated position; entering text or data into a computer; visual acuity; talking; hearing; repetitive arm, hand, and finger motions
- Working remotely some or all of the time
