- Resolve suspended medical claims utilizing Medical Assistance Policy.
- Entry and/or approval of medical Prior Authorizations.
- Entry and maintenance of third-party insurance information facilitates coordination of benefits and benefit recovery.
- Identification of accident-related claims.
- Research, entry, and maintenance of HCPC and CPT codes; Entry of nursing homes, hospitals, federally qualified health centers, and ambulatory surgical center rates.
- Typically requires 3 – 5 years of al experience, or an equivalent combination of experience and college-level education.
- Healthcare, insurance, or third-party billing experience helpful
- Self-motivated with excellent time management and organizational skills; ability to work independently.
- Experience with Microsoft Outlook, and Word, and proficiency with Excel
- Ability to interpret healthcare policy, laws, and regulations.
- On-site environment located in Warwick, RI.
- Hybrid is possible after training.
Claims Resolutions Analyst - Warwick, United States - Gainwell Technologies LLC
Description
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
Perform routine but moderately complex tasks related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policies to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalate only the most complex issues to the immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections, and data entry. Performs other duties as assigned. Involved in training new employees and may take the lead in areas of expertise.
Your role in our mission
What we're looking for
What you should expect in this role
#LI-HYBRID #LI-JW1
The pay range for this position is $30, $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.