Medical Claims Eligibility Specialist II-Hybrid

MET Healthcare Solutions; Texas; Híbrido; USD 52.000 - 78.000; Jornada completa

Descripción de la vacante

MET Healthcare Solutions is seeking a Medical Claims Eligibility Specialist II to join our fast-paced organization. The role analyzes level II claims information to determine eligibility in dispute resolution, in line with federal regulations and company policies.

The position requires a Bachelor's degree and 2 years of healthcare claims analysis experience, with a preference for Billing and Coding Certification.

Formación

• Bachelor's degree is required.
• Healthcare Claims Analysis experience of 2 years is required.
• Billing and Coding Certification is preferred.

Responsabilidades

• Analyze Explanation of Benefits (EOB) and remittance documents to determine eligibility for dispute resolution.
• Compose correspondence in accordance with regulatory requirements and internal policies.
• Communicate with healthcare providers and health plans via email to obtain necessary eligibility information.
• Relay the status of all claim submissions across multiple operating systems.
• Stay up to date on industry regulations and ensure appropriate strategies are in place.
• Maintain electronic files for all claims determined eligible.
• Review all types of medical claims, EOBs, and payment remittances (HCFA 1500, UB92, etc.).
• Understand insurance reimbursement rules and maintain confidentiality and professionalism.
• Demonstrate strong written and verbal communication skills and attention to detail.

Educación

Bachelor's degree

Descripción del empleo

Job Description

MET Healthcare Solutions is seeking a Medical Claims Eligibility Specialist II to join our fast-paced organization. The Medical Claims Eligibility Specialist II will be responsible for analyzing level II claims information to determine eligibility in the dispute resolution process in accordance with established federal regulations and company policies and procedures.

Responsibilities of the Medical Claims Eligibility Specialist II may include but are not limited to:

• Analyze Explanation of Benefits (EOB) and payment remittance documents submitted by healthcare providers and insurance carriers to determine which level II claims are eligible for the dispute resolution process.
• Compose correspondence in accordance with regulatory requirements (and internal policies in procedures) in a clear, concise, and grammatically correct manner.
• Communicate (via email) with healthcare providers and health plans to obtain information necessary to determine the eligibility of the claims.
• Relay the status of all claim submissions utilizing multiple different operating systems.
• Stay up to date on industry specific regulations, ensuring that appropriate strategies are in place.
• Maintain electronic files for all claims determined eligible.
• Experience reviewing all types of medical claims, EOBs, and payment remittances (e.g. HCFA 1500, Outpatient/Inpatient UB92, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing).
• Understanding of insurance reimbursement rules.
• Ability to work at a high level and display high attention to detail.
• Ability to work across multiple operating systems.
• Ability to maintain confidentiality and professionalism in difficult situations.
• Strong written and verbal communication skills with the ability to explain reasoning effectively.

These responsibilities are a condensed list of the full scope of the job description and are subject to change depending on the company’s demand.

This Medical Claims Eligibility Specialist II position is offered as a hybrid position (after in office training) to those candidates that meet all the position requirements and continue to meet the daily expectations.

This is a full-time position, Monday-Friday from 8am-5pm. Please only apply if you are able to meet these requirements weekly.

Education:

• Bachelor's (Required)

Experience:

• Healthcare Claims Analysis: 2 years (Required)

License/Certification:

• Billing and Coding Certification (Preferred)

Company Description

A healthcare management group, URAC-accredited as an independent review organization (IRO). Over 20 years of experience helping control costs, and mitigate regulatory compliance by providing superior administrative and medical expert services to improve the quality of healthcare functions nationwide. Making a difference in healthcare.