This position will contribute to the overall success of the business by building and maintaining effective working relationships and to oversee all activities related to provider relations of its provider network including but not limited to network provider communications; building and maintaining positive provider relationships; educational activities; assisting network provider with claims resolution activities; reviewing and resolving grievance related issues submitted to the organization.  This position will be responsible for the daily oversight of workflow of the payer service team and provider relations representative. Job requirements include, Team Leader or Supervisor Experience is required.   Knowledge of healthcare delivery system.   College degree desired, but relevant work experience may be acceptable.  Must have computer skills – Windows and Excel.  Excellent organizational, communication skills and creativity. 

 

Responsible for medical and dental claim analysis and benefit determination ensuring claim is processed accurately and timely in an automated environment.   This claims adjudication, not claims repricing.Minimum Job Requirements: a thorough understanding of CPT, CDT, ICD-9 coding guidelines and medical terminology, analytical problem solving skills and good communications skills, excellent data entry skills with knowledge of Microsoft Office.

 

Responsibilities include assisting customers with general questions. Requirements: detail oriented, organized, works well independently, possess good written and oral communication skills, typing speed of 30 words per minute and have analytical and problem solving experience. Customer service experience helpful.

Call Center servicing inbound calls. Candidate must be detail oriented, organized, possess excellent written and oral skills, and have analytical and problem solving experience. Previous experience in medical or insurance field preferred.

 

Explore the opportunities available for RNs to use their nursing experience and communication skills to perform utilization Review. Requirements: 3-5 years of recent clinical experience, excellent communication skills, positive attitude, and enjoy the computer. Work M-F 8:30 5:00. Currently filled, but accepting applications.