Highlights
Review paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers. Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims.
Numbers & Facts
| Location | Remote, VA (Remote) |
| Industry | Management Consulting Services |
| Salary | $18.62–$23.27 Per Hour |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | https://www.iconma.com/ |
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:
Requirements:
Why Should You Apply?
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
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
Benefits
401K, Employee Referral Program, Life Insurance
About Company
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.