by twochickswithasidehustle | Jul 14, 2023 | Uncategorized
Date Posted: Jul 13, 2023
Location(s): Remote, US, 0
Company: MetLife
Job Location: Fully Virtual
Schedule: This position requires work every weekend, either Saturday or Sunday – every weekend. In return you will have one weekday off every week.
Role Value Proposition:
The Claims Coordinator accurately reviews medical records and invoices, utilizing their understanding of pet health diagnoses and procedures, to evaluate coverage and equitably settle pet health insurance claims with respect to policy limits & terms. Communicates with the Insured, Veterinarian or Pet Adoption Agency to determine the details of the claim, requesting and verifying necessary documentation, and informs the Insured of claim status or claim outcome. Utilizes the workflow queues to perform job functions to include: claim entry/policy association, pre-adjudication, Insured/Veterinarian documentation requests, claim closeouts, claim appeals, and “good to go” claims processing.
Key Responsibilities:
- Requests and communicates with Insureds, Veterinarians, or Adoption Agencies for clarification of diagnosis/additional information necessary to accurately process claim
- Adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. Follows adjudication policies and procedures to ensure proper payment of claims
- Documents phone calls in system and follows up on issues if needed
- Resolves problems resulting from claim adjudication and communicates claim status and claim outcome with Insureds
- Prepares reports as required by management and enters/receives inbound documents as assigned
Essential Business Experience and Technical Skills:
Required:
- High school diploma or equivalency
- Three years veterinary medical experience or equivalency preferred
- Strong understanding of veterinary medical terminology
Preferred:
- Vet Tech License (HIGHLY PREFERED)
- Ability to operate in a fast-pace, multi-tasking environment with deadlines
- Strong written, verbal, interpersonal, and phone communication skills
- Strong computer background using MS Word, Outlook, Excel, and Internet and ability to learn quickly (to include our proprietary CRM system for managing customers)
Business Category
Pet Team – Group Benefits_01022
Number of Openings
4
At MetLife, we’re leading the global transformation of an industry we’ve long defined. United in purpose, diverse in perspective, we’re dedicated to making a difference in the lives of our customers.”
APPLY HERE
by twochickswithasidehustle | Jul 14, 2023 | Uncategorized
Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
Benefits info:
• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
This position is responsible for keying paper claims, evaluating and correcting on-line edits that are basic in nature, accessing and applying on-line instructions for the proper resolutions of claims suspension and initiating and responding to written and verbal communications from internal and external sources.
After the appropriate training, incumbents are expected to meet the minimum levels for quality as measured by the Quality and Performance Management department and by the Claims Department.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
Prepares first- level (redetermination) case file requests as requested by the Qualified Independent Contractor (QIC) and forwards these case files within the required timeframes established by CMS (Prep and Forward). This includes pulling information from imaging systems, the Multi Carrier System (MCS), letter writer systems, and the Healthcare Integrated General Ledger Accounting System (HIGLAS). Ensures case files that are being forwarded contain the required elements within the case files as outlined in established QIC procedures. (40%)
Resolves basic, on-line edits and performs data entry of hard copy claims. (30%)
Resolve edits on claims suspending on batch edits. (30%)
• Resolve fundamental and basic edits. This may include making basic mathematical calculations such validating accuracy of submitted charges, researching the Inter or Intranets, requesting additional information from the provider, etc.
Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
• High School diploma or GED
• 6 months’ work experience; this includes data entry experience and working on a PC in a Windows or similar environment.
• Demonstrated mathematical aptitude – ability to add, subtract, multiply and divide.
• Demonstrated effective interpersonal and verbal communications skills.
PREFERRED QUALIFICATIONS
• 1-3 years working with medical terminology, procedure and denial codes
• 1 year of experience in claims processing
• 1 year of experience in Medicare Fee For Service
• 1-3 years of experience as data processor
• 1-3 years meeting production and quality standards
APPLY HERE
by twochickswithasidehustle | Jul 14, 2023 | Uncategorized
Job Description
ABA Benefits and Authorizations Specialist
ABS Kids is looking for an ABA Benefit and Authorization Specialist to join our team REMOTELY! As a Benefit and Authorization Specialist, you will inform potential clients about ABA benefits, submitting initial assessment authorizations and ongoing ABA Therapy authorizations. This position’s main responsibility is to ensure ABA is a covered benefit and ABS will be reimbursed by ensuring that the client is covered with an authorization.
NOTE: Due to the high volume of applications, we are only able to respond to candidates that are selected for an initial interview. We appreciate your understanding and interest in ABS Kids!
Our Administrative Support team members play a vital role in advancing our mission to make a difference in the lives of children with autism spectrum disorder and their families. Every team member at ABS Kids is passionate about providing best in class support to our direct care providers, who in turn deliver the highest quality ABA therapy to our patients.
What would you do?
- Works with Regional Directors and Intake team to fulfill BCBAs caseloads
- Understands and explains to clients what their Insurance policy covers and what process and documents we have to have in order to authorize and service ABA.
- Resolves customer complaints via phone or email.
- Compliance in CR software to “task” Consultants when re-authorizations are due
- Verifying Medicaid eligibility monthly and working with families and Consultants to hold therapy if applicable (Medicaid ineligible)
- Obtain benefits and authorization for commercial payors
- Adding codes to electronic health records system once authorization is obtained for converting and billing purposes
- Problem solving when Behavior Interventionists and Consultants are unable to convert time sheets
- Adhere to Federal HIPAA Regulations
Who are we looking for?
- High school diploma or GED
- 2 years+ in a customer service role
- Simple math requirements
- 2 years+ of Medical or Mental Health field administrative experience
- Excellent interpersonal/communication skills
- Ability to think critically and multitask
- High attention to detail
- Computer literacy skills in Microsoft Office
What do we offer?
- $18 – $19 hour – based on qualifications
- Full benefits
- Remote work environment
- Opportunities for advancement
Who We Are:
- ABS Kids is dedicated to empowering children with autism spectrum disorders and their families to reach their full potential – helping them learn, grow and reach incredible milestones.
- We take pride in our stellar support for providers, so they can do what they do best – deliver the highest quality ABA Therapy to our patients.
- At ABS Kids we are empowered by the breadth of our differences. Our mission is to create a culture where all people thrive because their diverse stories are heard and celebrated. We commit to an evolving understanding of diversity as we learn from one another.
- We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
APPLY HERE
by twochickswithasidehustle | Jul 13, 2023 | Uncategorized
The job
We connect you with people shopping for products. You learn about their needs, then pair them with the right gear. When people buy through Curated, you earn commission and tips.
The people
As a Curated expert, you can earn from anywhere with WiFi. You’ll work with a supportive team of people who share your love of gear and passion for your sport.
APPLY HERE
by twochickswithasidehustle | Jul 13, 2023 | Uncategorized
WHO IS REALITY BASED GROUP?”
We are a customer experience management and mystery shopping company. We help companies evaluate and improve their front line staff and their behaviors that drive customer loyalty and revenue. Using programs like mystery shopping and customer surveys as the vehicles to allowing companies to have conversations about the behaviors that drive their customer experience.
WHY MYSTERY SHOP WITH RBG?
The reason is simple. We always go the extra mile for our mystery shoppers! Because without our shoppers, the pieces of the puzzle won’t fit!
We have some of the best mystery shoppers in the industry and we take pride in setting them up for success. When mystery shopping with RBG, our shoppers are assigned a scheduler and have access to customer service representatives who are here to help you along the way. This is just one of many ways we make sure that you have all the resources needed to help make you a successful mystery shopper. Don’t just take our word for it. Check out our shopper testimonials to learn more about shopping with RBG.
APPLY HERE
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