Title: Medical Claim Representative
Location: Aguadilla, PR
Type: Fulltime
Job description:
- Responsible to read received medical records, review the claims on NASCO system and review medical necessity.
- Investigate and determine the correct department to refer or transfer records received.
- Working along with the clinical team of Horizon CPCS and navigate in an average of 10 different platforms to gather all pertaining data (Patient, Claim, CPT, ICD10, Date of Service, Member benefits, related services, Authorizations, all related attachments) subsequently send data to nurses for further review.
- Decide per reviewing benefits, Auth, determination received from the clinical team.
- (Approve, deny claims, or request Additional Information) in the system, based on Claim scenario.
- Create claims letters (If applicable) to the member and providers (that apply).
Requirements:
- Previous claims experience
- Excellent communication, organization, and problem-solving skills.
- Ability to read and understand English.
- Computer literate and Knowledge in MS Office Suite.
- Excellent written and oral communication skills.
- Analytical and innovative mindset to handle multiple tasks and meet deadlines.
- Full availability including weekends.
- Data entry experience (recommended)
- Medical claims experience
- Overtime will be required based on business needs.
- Pass training and client assessments
- Full time / adherence to schedule provided.
Job Type: Full-time
Pay: $9.00 - $12.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- Monday to Friday
- No weekends
Work Location: In person