HealthLock Medical Claims Auditor / Advocate II

HealthLock Medical Claims Auditor / Advocate II

Be a part of a rapidly growing and dynamic healthcare company!

HealthLock is one of the nation's leading providers of Healthcare Management Solutions utilizing our Medical Claims Auditors / Advocates, extensive analytics and customized technology solutions. Driven by our commitment to our clients, we pride ourselves in our ability to ensure our clients receive the best service possible.

Job Role:

· Review patient medical bills, correspondence and Explanation of Benefits (EOBs) for accuracy

· Communicate with Insurance Companies and Providers to address any issues that are identified (e.g., appeal incorrectly denied claims, coordinate with providers to fix billing errors, negotiate with providers in the case of inappropriate billing)

· Communicate with clients via phone and email – respond to client requests in a timely and professional manner, go above and beyond to make sure concerns are addressed and medical bills and associated paperwork is no longer a worry

· Provide client support with benefit/health insurance questions

· Identify problems and inconsistencies by using management reports

· Summarize findings and make recommendations to resolve claims/billing issues

· Work on special projects for other divisions ie. EmployeeCare, Individuals, TotalCare

Job Requirements:

A background in medical billing or insurance claims administration (Medical Billing, Coding and Collections Specialists, and/or Health Insurance Claims Administrators strongly preferred)

• 3-5+ years experience in Medical Billing, Coding, A/R follow up and Collections experience preferred, including manual Out of Network (OON)
• Extensive Explanation of Benefits (EOB) knowledge
• Experience with Out of Network (OON) Benefits a plus
• Understanding of general Coordination of Benefit Rules, Benefit Analysis
• Knowledge of eligibility requirements and enrollment
• Experience in overturning claim denials - ranging from simple solutions such as coding correction to more complex, involving submission of appeals and grievances
• The desire to be part of a team of professionals that have fun while really making a difference to our clients
• Proficient with Microsoft Office
• Ability to think outside the box with excellent time-management skills and deadline management
• Problem solving skills that persist to a solution
• Excellent organizational and scheduling skills
• Ability to multi-task, while working with a sense of urgency
• Ability to prioritize many coexisting projects
• Self motivated / Self Starter
• Reliable
• Knowledge of CPT/ ICD- 9 and 10 is required. Medical Billing and / or Coding Certificate a plus
• Excellent communication and customer service skills – must be able to communicate effectively with Clients, Insurance Companies, and Providers both in writing and over the phone, including how to write appeal letters
• Website Navigation of carrier web portals to find info relative to resolution and/or claim processing
• Experience investigating and research for appeals and drug manufacturer websites for copay assistance
• Extensive phone experience with carriers and providers
• Strong interpersonal skills

Benefits you will enjoy when you join our team:

• Extensive paid training
• A supportive team environment
• Advancement opportunities
• Benefits, including medical, dental, vision, 401K and life insurance
• Generous PTO and paid Holidays
• Part time and full time opportunities available

Job Type: Full-time

Pay: $21.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• Office

Work Location: In person