Remote Claims Investigation Analyst I

geisinger; United States; A distancia; USD 55.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Healthcare benefits from day one (incl

Vision

Descripción de la vacante

Geisinger, a health system based in Pennsylvania, is seeking a Regular, full-time claims specialist working from home in the United States. The role resolves complex claims issues using state and federal guidelines, coordinating with providers, internal teams and vendors to ensure accurate payments and timely communications.

You will educate providers on submission requirements, coding updates and electronic transactions, while collaborating with Account Management and customer service to

Formación

• Education: High School Diploma or Equivalent (GED) - (Required).
• Experience: Minimum of 4 years - Relevant experience (Required).
• Certification(s) and License(s):
• Skills: Communication, Multitasking, Organizing, Teamwork.

Responsabilidades

• Acts as the technical claims expert, following state and federal guidelines and provider contracts.
• Educates providers regarding claims submission requirements, coding updates, EFT and resources such as provider manuals and fee schedules.
• Provides on-site professional guidance to facilitate issue resolution.
• Evaluates and resolves complex claim and provider billing issues in a timely manner and per standards.
• Coordinates with the provider and Account Management team on claims processing issues and follow-up with impacted parties.
• Works with customer service to ensure accurate interpretation of billing guidelines and contract terms; escalates as necessary.
• Interfaces with the call center to analyze and disseminate information from provider calls.
• Provides feedback to configuration team to ensure payment terms are set-up correctly.
• Assists with claims audits to ensure accurate payments to providers.
• Responds to provider inquiries regarding claims payments.
• Communicates with providers to gather feedback on submission practices.

Conocimientos

Communication

Multitasking

Organizing

Teamwork

Educación

High School Diploma or GED

Descripción del empleo

Geisinger, a health system based in Pennsylvania, is seeking a Regular, full-time claims specialist working from home in the United States. The role resolves complex claims issues using state and federal guidelines, coordinating with providers, internal teams and vendors to ensure accurate payments and timely communications.

You will educate providers on submission requirements, coding updates and electronic transactions, while collaborating with Account Management and customer service to