医疗福利审查服务专员
Medical Benefit Review Services Associate
医疗福利审核专员
薪资：每小时18美元起（根据经验而定），可能低于您所在州的最低工资标准。请在申请时考虑这一点。
排班：周一至周五 | 美东时间上午8:00 - 下午4:30
地点：完全远程
职位简介：
您是否具备多种医疗福利和服务的经验？我们正在寻找一位注重细节的医疗专业人员，喜欢解决复杂的保险账单和覆盖问题，并能在快节奏的远程环境中工作。
医疗福利审核服务专员II负责通过访问与Medicare、Medicaid和商业索赔超额支付相关的客户索赔系统，为CPIS超额支付计划提供分析支持。
如果您具备出色的分析能力，喜欢研究保险资格和医疗索赔，并以交付准确、高质量的工作为荣，我们期待您的加入。
主要职责：
- 负责（但不限于）以下工作：
- 审核已支付的索赔、调整后的索赔和抵扣索赔。
- 审核成员资格，更新成员资格信息。
- 调查并沟通可疑情况。
- 在相关系统中记录从客户系统获取的调查结果。
- 与其他员工/团队成员有效沟通。
- 根据既定流程独立工作。
必备资格：
- 申请者须年满18岁
- 需具备高中文凭或同等学历
- 需通过就业前的犯罪背景调查和药物检测
- 具备福利/覆盖概念背景者优先
- 了解保险流程，与保险公司合作，熟悉Medicare和Medicaid
- 具有数据录入/医疗索赔数据录入经验
- 需具备专业的口头和书面沟通能力
- 熟练使用Microsoft Office（Word、Excel和Outlook）
- 理解医学术语和医疗资格流程
- 出色的调查、研究和批判性思维能力
- 优秀的口头和书面沟通能力
- 强大的组织能力和多任务处理能力
- 能够在远程团队中独立工作并有效协作
为什么你会喜欢这个机会
- 完全远程职位
- 灵活的周一至周五排班
- 不需要周末工作
- 有竞争力的起薪
- 协作型团队环境
- 有资格享受福利
查看英文原文
Medical Benefits Review Associate
Pay: Starting at $18.00/hour (based on experience), which may be below your state's minimum wage. Please take this into consideration when applying.
Schedule: Monday-Friday | 8:00 AM -4:30 PM EST
Location: Fully Remote
About this role:
Are you experienced in various types of medical benefits and services? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance billing and coverage issues and working in a fast-paced remote environment.
Medical Benefit Review Services Associate IIis responsible for providing analytical support to CPIS overpayment programs via access to the client claims systems related to Medicare, Medicaid and Commercial claim overpayments identified through various audits.
If you have strong analytical skills, enjoy researching insurance eligibility and medical claims and take pride in delivering accurate, high-quality work, we'd love to hear from you.
Key Responsibilities:
- Responsibilities include (but are not limited to):
- Review of paid claims, adjusted claims, and offset claims in the client system.
- Review of member eligibility, update of member eligibility.
- Investigates and communicates questionable situations.
- Documents findings from the client system in the related systems.
- Communicate effectively with other staff/team members.
- Works independently based on established procedures.
Required Qualifications:
- Must be 18 or older to apply
- Must have a high school diploma or GED
- Must be able to successfully pass a preemployment criminal background check and drug screening
- Background in benefit/coverage concepts desired
- Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid
- Experience with data entry / medical claims data entry processing
- Professional verbal and written communication skills required
- Proficiency with Microsoft Office (Word, Excel, and Outlook)
- Understanding of medical terminology and healthcare eligibility processes
- Strong investigative, research, and critical thinking skills
- Excellent verbal and written communication skills
- Strong organizational and multitasking abilities
- Ability to work independently while collaborating effectively with a remote team
Why You'll Love This Opportunity
- Fully remote position
- Flexible Monday-Friday schedule
- No weekends required
- Competitive starting pay
- Collaborative team environment
- Eligible for benefits day 1
If you're an experienced healthcare professional with a background in various form of medical benefits, insurance verification, medical billing, or healthcare claims, we'd love to hear from you. Apply today!
Due to varying state and local minimum wage laws, we are currently only able to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time.
Requirements:
- Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)
- Must have the ability to connect with an ethernet cable to a modem/router
- Live in one of the following states, AL, AR, AZ, CO CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ,NM, NC, OH, OK, PA, RI, SC, SD, TN, TX,UT, VT, VA, WA, WV, WI, WY
We are currently NOT hiring in the following geographies, included but not limited to:
States: AK, CA, CT, HI, MA, IL, MT & NY
Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC
Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $34,320-$42,900.
Originally posted on Himalayas