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SalarySummary
Researches and resolves escalated, complex, and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include, but not limited to provider enrollment, medical review, appeals and/or finance. Completes research efficiently and accurately to ensure the departmental goals are achieved.Description
Location:
Columbia, SC
WFH after 2-3 Month Training.
What You'll Do:
- Research and resolves high profile claims issues.
- Ensures claims processing errors are corrected according to the appropriate provider reimbursement contract.
- Research and resolve high profile issues including, but not limited to provider enrollment, medical review, appeals and/or finance, which may be received via written or telephone correspondence.
- Serve as Point of Contact for various providers (professional and facility) to resolve all claims payment errors.
- Conduct weekly conference calls with assigned providers to ensure open communication pertaining to all current issues.
- Communicate/educate providers on proper coding of claims, claims filing, pricing concerns, contract questions, benefit/system updates, etc.
- Determines if claims payment errors are the result of system issues.
- Troubleshoot, and/or coordinates the resolution/correction of the system processing error.
- Verifies disbursement requests to ensure the request is valid and appropriately documented.
- Research rejected, transition, and paid status claims for validity and escalate as appropriate.
- Use the various systems of the department/company to complete research.
- Monitors inventory reports to ensure claims are resolved accordingly.
- Provides documentation as requested for audit purposes.
- Provide written or telephone correspondence to resolve claims issues.
To Qualify for This Position, You'll Need:
- High School Diploma or equivalent.
- Five years of combined claims and provider service experience in a healthcare environment.
- Three years of experience with claims systems (may be concurrent).
- Required Software and Tools: Standard office equipment.
Required Skills and Abilities:
- Comprehensive knowledge of claims payment policies and refund policies.
- Working knowledge of related claims software systems.
- Knowledge of medical terminology and coding as appropriate.
- Strong analytical skills and the ability to retrieve and research automated reports.
- Strong time management skills and adaptable to change.
- Strong communication (verbal and written) communication skills.
Our comprehensive benefits package includes the following:
- 401(k) retirement savings plan with company match
- Fantastic health plans and free vision coverage
- Life insurance
- Paid annual leave — the longer you work here, the more you earn
- Nine paid holidays
- On-site cafeterias and fitness centers in significant locations
- Wellness programs and a healthy lifestyle premium discount
- Tuition assistance
- Service Recognition
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
