Kelly Services is seeking an experienced Healthcare Reimbursement Case Advocate for our global medical manufacturing client in Columbia, MD. This is a full time, temp to hire position paying $23.00/hr. to start with benefits avaible in the first 30 days. Pay increases to $26.50/hr. with full benefits upon hire. Monday-Friday 8am to 5pm schedule.
The Reimbursement Case Advocate (RCA) is responsible for supporting various reimbursement functions, including but not limited to Intake, Data Entry, Benefit Investigations, Call Triage, Prior Authorizations, Pre- Determinations, and Appeals support. The Reimbursement Case Advocate (RCA) responds to all provider account, patient, and internal inquiries in a timely fashion. The Reimbursement Case Advocate (RCA) will appropriately document all interactions with provider, payer and related customers into the client database system.
• Acts as single point of contact and voice for all providers, patients and product / sales team.
• Serves as a patient advocate and enhances the collaborative relationship between, payer, provider and sales team.
• Primary function is to provide Prior Authorization, Pre-Determination and Appeals support to customer.
• Proactively reviews all clinical notes with benefit verifications to be sure coverage criteria is met per payer guidelines.
• Analyzes data and draws valid and logical conclusions based on information provided by insurers and documented medical policies.
• Tracks and follows up on all PA, PreD requests and reports on status updates to customer.
• Performs a detailed insurance verification for all product and applicable procedures to the degree authorized by the SOP of the program.
• Manages a regional case load.
• Provide assistance to physician office staff to complete all necessary PA/Pre-D forms and gather any missing information in a timely manner to submit to insurance payers.
• Provides all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
• Initiates and coordinates the insurance verification for physicians, hospitals, and ambulatory surgery centers for all company products as needed.
• Accurately records all reimbursement correspondence and research in the database per the assigned fields and required metrics.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Prioritizes duties and tasks as necessary to ensure assignments are completed in a timely fashion. Reports any reimbursement trends/delays to Team Lead.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.
• Performs related duties as assigned.
• 1-3 years of customer service and reimbursement experience within the biotechnology, healthcare or pharmaceutical industry with Hub Services
• Knowledge of Medicare, Medicaid, and Private Insurer Reimbursement Methodology
• Able to interpret and analyze detailed Medical policies
• Basic understanding of the benefits investigation process [deductible, out of pocket, benefits exclusions, etc.]
• Familiar with ICD 10 Coding
• Familiar with Wound Care
• Proficient in MS Office
• Excellent organizational, written and verbal communication skills
• Ability to work professionally with highly confidential information, in work consistently in a fast-paced environment
• Experience with Microsoft based applications, and ability to learn internal computer systems
• Flexibility and ability to adjust to changing priorities and unforeseen events
• Previous coding and billing experience in provider office or hospital setting
• Bachelor’s Degree preferred
In addition to working with the world’s most recognized and trusted name in staffing, Kelly employees can expect:URL blocked - click to apply
- Competitive pay
- Medical, Vision, and Dental insurance options
- Paid holidays
- Year-end bonus program
- Recognition and incentive programs
- Access to continuing education via the Kelly Learning Center
Important information: This position is recruited for by a remote Kelly office, not your local Kelly branch. To be considered for this position, you must use the “submit now” button below to submit your resumes. If you have questions about the position, you may contact the recruiter recruiting for this position (Melody at Email blocked - click to apply) however your resume must be received via the “submit now” button included within.
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Kelly Services® is a U.S.-based Fortune 500 company. With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world.
Kelly Services is an Equal Opportunity Employer.
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