CHAT JOBS
Claims Resolution Specialist
Job Description
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external – driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
Do you know someone who you think would be a great fit for this position? To share this job with someone, click the refer-a-friend icon at the top of this page. This icon is to the right of the star icon.
JOB SUMMARY: This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client.
JOB ROLES AND RESPONSIBILITIES:
1. Manage a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards.
* Perform provider research to provide support for desired savings.
* Address counteroffers received and present proposal for resolution while adhering to client guidelines and policy and procedures.
* Seek opportunities to achieve savings with previously challenging/unsuccessful providers.
* Seek opportunities to establish ongoing global or concurrent agreements for future claims.
* Update provider data base for reference and claims processing on subsequent claims.
2. Initiate provider telephone calls as often required with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
* Up to 40% of time will be on phone with providers.
* Provider education to providers online provider portal services available for proposal review and approval
3. Meet and maintain established departmental performance metrics.
4. Handle post claim closure service inquires, including payment status and defending original negotiation terms.
5. May require ACD phone responsibilities and tracking outcomes.
6. Collaborate, coordinate, and communicate across disciplines and departments.
7. Ensure compliance with HIPAA protocol.
8. Demonstrate Company’s Core Competencies and values held within.
9. Please note due to the exposure of PHI sensitive data — this role is considered to be a High-Risk Role.
10. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.
JOB SCOPE: The Individual adheres to company policies and customer specific procedures to meet control standards. The Individual relies on established instructions and procedures, applies basic skills, and may develop advanced skills using tools and equipment appropriate for the position. Duties and tasks are standardized and generally contain written instructions, allowing an individual to resolve routine questions and problems, and referring more complex issues to a higher level. Work is subject to defined work output standards and production which involves high volume claims resolution. Work involves direct contact with internal and external customers.
Requirements
JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum high school diploma or GED
* Minimum 6 months experience in the health care industry (provider billing, medical coding, provider collections, insurance, or managed care); 1 year preferred.
* State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with MultiPlan practice and policy.
* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers’ Compensation or automobile medical (“auto”) bills a plus
* Knowledge of general office operations and/or experience with standard medical insurance claim forms
* Good Communication (verbal, written and listening) teamwork, negotiation, and organizational skills.
o Ability to process verbal and written instructions.
o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment.
* Ability to:
o Commit to providing a level of customer service within established standards.
o Provide attention to detail to ensure accuracy including mathematical calculations.
o Identify issues and determine appropriate course of action for resolution.
o Organize workload to meet deadlines and participate in department/team meetings.
o Adjust/alter workflow to meet deadlines in a fast-paced environment.
o Work independently and handle confidential information.
* Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software.
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.
The salary range for this position is $20.32 per hour. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical (PPO & HDHP), dental and vision coverage
- Pre-tax Savings Account (FSA & HSA)
- Life & Disability Insurance
- Paid Parental Leave
- 401(k) company match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
- 10 paid company holidays
- Tuition reimbursement
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
APPLICATION DEADLINE
We will generally accept applications for at least 15 calendar days from the posting date or as long as the job remains posted.
#LI-SW1
Process Clerk
Job Details
Remote Type
Fully RemotePosition Type
Full Time
Description
About Us:
Magna Legal Services provides end-to-end legal support services to law firms, corporations, and governmental agencies throughout the nation. As an end-to-end service provider, we can provide strategic advantages to our clients by offering legal support services at every stage of their legal proceedings.
Job Description:
Job Title: Process Clerk
Position Summary:
Magna Legal Services is seeking a Process Clerk to join our team! Our ideal candidate will have strong communication skills, be able to work in a fast-paced environment, be meticulous about paying attention to details, and have good work attendance. Additionally, we are looking for an employee who: can multi-task, is a quick learner, can retain information, can think outside of the box, and can adapt to change.
Key Responsibilities:
- Communication with clients and/or process servers (phone and/or email)
- Preparing documents to be served (i.e., data entry, scanning, copying, etc.)
- Preparing basic legal documents
- Assisting other department members on miscellaneous tasks as needed
- Reviewing various documents for accuracy
- Keeping up with various clients needs and requirements.
- Dispatching assignments to process servers.
Qualifications:
- The ability to accurately type at least 50 wpm
- Knowledge of the legal field, including at least 2 years of relevant work experience (i.e., working for: an attorney service, process serving company, private investigations company, records retrieval company, law firm, etc.) *Please note that candidates without relevant experience will not be considered for this role
- An associate’s degree or higher is preferred (but not mandatory)
- Candidates with Texas SOP experience will be preferred.
Compensation: USD $19.00 – $24.00 per hour.
An employee’s pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, seniority, geographic location, performance, travel requirements, revenue-based metrics, any contractual agreements, and business or organizational needs. The range listed is just one component of the total compensation package for employees.
Magna Legal Services provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Research Clerk I
Full-Time- Remote
- LocationsShowing 1 locationColumbus, OH 43231, USA
Job Details
Description
Researches utility termination warnings, potential missing bills, and late fees. Analyzes payment history, negotiates and arranges payment with utility vendors, or executes alternative solutions as deemed necessary to avoid client shut off of utility service. Responsible for the removal of client’s late fees. Responds to calls received via the hotline.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
- Under direct supervision, researches utility termination warnings, potential missing bills, and late fees by reviewing payment history, account posting, and status of check clearing to determine whether further action is required on notices according to department procedures.
- Contacts utility vendors via telephone to determine reason and amount of balance due. Verifies address and that payment have been applied to proper account.
- With guidance, negotiates a date extension for receipt of payment or arranges alternative solutions to avoid a client shut off of utility service. In addition, negotiates with the vendor removal of late fees and penalties assessed to the account.
- Prepares and provides written correspondence via email or fax of copy of check remittance to vendors as deemed necessary to resolve shut off possibility. Request replacement bills from vendor as needed.
- Processes payment research items such as misapplied and stop payments, reissue checks, and pay now. Responsible for working closely with internal staff and vendors to minimize and correct errors, answers inquires, and resolves bill and account discrepancies.
- With some supervision, operates the termination research, missing bill, and late fee databases. Organizes daily work within the termination research, missing bill, and late fee databases utilizing department standards and procedures in prioritizing and identifying the most critical research items.
- Review and contact vendors listed on various late fee reports monthly. Determine which vendor’s late fees should be targeted and contact vendor to request removal charges based on established departmental procedures. Document the results and status of the phone call in the late fee database.
- Answer vendor hotline and assist vendors with questions on a timely basis, within 2 hours of receipt of call or message.
- Contact vendors who bill summary and round up/donation invoices and have the clients removed from those specific billing formats. Follow up on outstanding requests to ensure they have been removed.
- Provides and maintains concise documentation of research, accurate production task time sheets, and updated departmental standards and procedures.
- Works overtime as required by management.
- Other duties as assigned by management.
SKILLS AND ABILITIES REQUIRED:
- Ability to effectively communicate both verbally and written and maintain a positive composure.
- Possess good interpersonal skills.
- Possess organizational skills in order to handle multiple tasks simultaneously and prioritize work.
- Ability to operate standard office equipment including, but not limited to, computers, copiers, calculators, and facsimile machines.
- Ability to perform basic functions in the Microsoft Office suite.
- Good analytical and problem-solving skills.
MINIMUM LEVEL OF PREPARATION AND TRAINING NORMALLY REQUIRED:
- High school diploma or equivalent required.
- 6 months of previous telephone experience normally acquired working in a customer service or collection position or equivalent work experience.
- General knowledge of the principles and practices of the utility billing process.
APPLICATION PROCESS:
You can directly apply through Cass’s website at https://www.cassinfo.com/careers. Please apply directly to this position via the “Apply” button. You will be required to create an account and provide your resume, contact information and other pertinent employment information. This process typically takes 20 minutes or less. Should we find that you meet the minimum requirement of the position, a member of our recruiting team will be in touch to start the interview process.
ABOUT OUR COMPANY:
Cass Information Systems, Inc. is a leading provider of integrated information and payment management solutions. Cass enables enterprises to achieve visibility, control and efficiency in their supply chains, communications networks, facilities and other operations. Disbursing over $90 billion annually on behalf of clients, and with total assets of $2.4 billion, Cass is uniquely supported by Cass Commercial Bank. Founded in 1906 and a wholly owned subsidiary, Cass Commercial Bank provides sophisticated financial exchange services to the parent organization and its clients. Cass is part of the Russell 2000®. More information is available at www.cassinfo.com.
Recent Comments