Opportunity Description
Our Client, a Leading Provider of Healthcare Delivery Systems and Solutions company, is looking for a Claims Resolution Representative for their Remote location. Responsibilities:
+ Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments.
+ Determine when 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 excellence.
+ Perform manual pricing and audit checks...
+ Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments.
+ Determine when 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 excellence.
+ Perform manual pricing and audit checks...
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