Job Description

Job Description

Job Description

Provider Reimbursement Claims Adjuster – Pittsburgh , PA

Company is nationally and globally recognized as being within the Top 100 Inspiring and Healthiest Workplaces in North America.

Status: Full-Time with Benefits – Direct Hire as an employee of the Company
Shift : Monday – Friday, daylight hours
Location : Remote Work from Home AFTER ON-SITE TRAINING PERIOD IN PITTSBURGH, PA 15222

Intermittent Travel Required : Must be able to travel to provider sites or regional offices

Salary Range : up to $27.00 per hour as a new hire. Performance-based increases can be earned, after hire

Benefits:

• Earn over 5 weeks of paid time off every year with the opportunity to buy and sell more, plus 7 paid holidays
• Affordable medical, dental & vision coverage, Employer-paid life insurance, comprehensive health care for dependents and emergency child and elder care options
• Student loan assistance and tuition reimbursement for you and qualified dependents - Up to $6,000 of annual tuition assistance
• Earn up to 8% of your eligible pay in retirement company-paid contributions
• Career advancement opportunities, ongoing learning, and dedicated career ladders
• Dedication to providing world-class benefits to employees through so many more benefits!

Job Duties:

This is a phone-based role so candidates must be comfortable spending most of the day on the phone.

• Request system reports to facilitate resolution of assigned provider’s claims issues.
• Advise the senior claims staff of any irregularities in physician or provider billing procedures.
• Work with the Director to develop and provide provider claims training.
• Responsible for understanding and performing job responsibilities consistent with the company’s mission statement, values statement, code of conduct and global goals.
• Interface with TPA to facilitate and expedite claims payment including question resolution, benefit interpretation and authorization.
• Schedule review meetings with providers to discuss issues or represent Claims
• Quality control functions including accuracy review and efficiency of the claims vendor’s processing of claims and the development of action plans for problem resolution.
• Develop spreadsheets to be sent to TPA to correct claims.
• Follow-up on claims checks, technical questions, or adjustment requests.
• Responsible for monitoring of assigned providers.
• Screen, evaluate, edit and correct claims and determine eligibility for payment.
  

Minimum Qualification Requirements :

• High school diploma or equivalent required
• Provider reimbursement experience in a call center setting, must have call center experience
• 4 years claim form experience in a medical setting or medical billing experience.
• Demonstrated analytical, oral, and organizational skills and sense of responsibility required
• PC proficiency in a windows environment for word processing and spreadsheet software.
• Knowledge of behavioral health terminology, ICD/9 and Medicaid procedure coding.
  Competency in typing required.

Job Tags

Hourly pay, Holiday work, Full time, Remote job, Shift work, Monday to Friday,

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