Claims Research Specialist

At Medusind we take immense pride in offering superior, cost-effective solutions covering the whole spectrum of tasks and processes to the healthcare industry. A significant factor is that our workforce comes with rich domain expertise and robust compliance norms.

Our four-prong approach of an excellent management team coupled with a detailed eye for processes experienced manpower, and cutting-edge technology helps us deliver superior, cost-effective services to our clients across the globe.

Position Details: Fulltime, fully remote, $21.50 Hourly.
 

Primary Job Responsibilities:

• Research and document denials in a thorough, professional and expedient manner.
• Analyze denied claim explanation of benefits, insurance carrier contacts, and general correspondence from insurance companies.
• Request medical records from internal staff when needed.
• Compose all correspondence in accordance with regulatory requirements, to reflect accurate appeal information in a clear, concise, grammatically correct format.
• Maintain tracking system of correspondence and outcomes for appeals.
• Maintain well-organized, accurate and complete files for all appeals.
• Monitor each appeal to ensure all internal and regulatory timelines are met.
• Act as point of contact for submission and/or resolution of denial determinations and interfaces with insurance companies in regard to reconsiderations, disputes and/or appeals.
• Responsible for data collection and analysis regarding specific denial determinations and appeals.
• Develop necessary policies and procedures and oversees quality assurance measures related to appeals.
• Review denied claims looking for large trend issues.

Skill Requirements:

• Must have experience appealing denied insurance claims for out of network providers (preferably in behavioral health).
• Computer literacy and proficiency in programs such as Microsoft Excel and Word.
• Understanding of state and regulatory grievance and confidentiality regulations.
• Ability to handle confidential material with discretion and integrity.
• Excellent verbal and written communication skills.
• Ability to establish and maintain positive and effective work relationships with coworkers and clients.
• Ability to work independently as well as in team environment.