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Claims Resolution Representative

ICONMA

Role overview

Qualifications

  • High School Diploma or GED
  • 1+ years of experience conducting research to resolve issues within the healthcare field
  • Strong computer skills, including proficiency in MS Word and Excel
  • Excellent oral and written communication skills

Responsibilities

  • Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments.
  • Review and analyze claims and follow up on the status of claims and reimbursement.
  • Ensure accuracy and consistency in claims processing.
  • Interpret and apply policy and reimbursement rules to support provider inquiries.

Key facts

Hard skills

Adjudication Conflict Resolution Policy Analysis Data Entry Customer Success Management

Other skills

  • Customer Service
  • Research
  • Time Management
  • Organizational Skills
  • Microsoft Word
  • Microsoft Excel
  • Leadership
  • Communication
  • Teamwork
  • Empathy
  • Problem Solving

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job 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 to ensure compliance with policies and rules.
  • Review and process suspended claims and submitted documentation.
  • Provide sufficient detail to explain claims denial reasons.
  • Implement workflow processes and capabilities for work queues with the ability to route workstreams.
  • Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims.
  • Perform manual reviews on claims, documents, and attachments.
  • Release individual claims for providers on review.
  • Independently resubmit claims with applicable corrections.
  • Independently address discrepancies in charges, payments, adjustments, and demographic information.
  • Facilitate manual entry of claims into the system.
  • Review paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers.
  • Other duties as assigned.
  • Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
 
Requirements:
  • High School Diploma or GED
  • 1+ years of experience conducting research to resolve issues within the healthcare field
  • Preferred Qualifications
  • Ability to maneuver through various computer claims and eligibility platforms simultaneously
  • Outstanding customer satisfaction skills
  • Must be firm but professional when interacting with contacts while performing tasks
  • Friendly personality, tact, patience, empathy, and a helpful yet professional attitude are essential
  • Strong computer skills, including proficiency in MS Word and Excel
  • Excellent oral and written communication skills
  • Excellent organization and time management skills, with the ability to establish priorities effectively
  • Ability to read, write, and follow directions
  • Self-directed and capable of working without direct supervision
  • Ability to collaborate effectively with others
  • Create and maintain a positive atmosphere, demonstrating leadership qualities
  • Knowledgeable in claims review and analysis
 
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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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