Healthcare Specialist
hace 1 semana
Job Summary:
The Healthcare Specialist will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that do not require a clinical review. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. The Healthcare Specialist will escalate medical review request and/or denial activities to the Prebill Denials Nurse.
**Responsibilities**:
- Work prebill accounts imported into the PDU Tool efficiently and effectively on a daily basis to resolve accounts with “no auth numbers and ALOS vs. authorized days variances
- Work assigned accounts in eRequest to resolve outstanding issues
- Report insurance denial trends identified during daily operational assignments
- Identify problem accounts and escalate as appropriate
- Document actions taken on the account clearly and concisely
- Contacting the facilities, physicians’ offices and/or insurance companies to resolve denials/appeals
- Adhere to time and attendance policies
- Adhere to all policies and procedures, including phone and internet usage, break utilization, etc.
- Participate in ongoing education and training as needed
- Establish and maintain relationships with all customers
- Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
- Adheres to established policy and procedure and escalates issues through the established Chain of Command
- Demonstrates commitment to teamwork and cooperation
- Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
- Other duties as assigned
Skills and Experience:
- English Level B2+ / C1
- High school diploma
- One year of CS and Back Office experience required. Experience in the following areas: appeals, denials, managed care, verifications/notification, precertification experienced preferred
- ** Communication** - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
- ** Customer orientation** - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- ** Interpersonal skills** - able to work effectively with other employees, patients and external parties
- ** Policies & Procedures** - demonstrates knowledge and understanding of organizational policies, procedures and systems
- ** Basic skills** - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.
-
Healthcare Specialist
hace 7 meses
Heredia, Costa Rica Auxis A tiempo completoJob Summary: You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually. In your role, you will be working to resolve patient...
-
Jr. Healthcare Specialist
hace 7 meses
Heredia, Costa Rica Auxis A tiempo completoJob Summary: The Jr Health Care Specialist will review post-discharge, prebill accounts that do not have authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that does not require a clinical review. Communicates with third-party payors to resolve...
-
Customer Service Specialist Ii
hace 7 meses
Heredia, Costa Rica AbbVie A tiempo completo**Company Description** **Responsibilities: - Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor. -...
-
Billing Specialist
hace 1 semana
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: Tebra is looking for a Billing Specialist(s) that will perform various activities to support our company's accounting department and billing processes. **Your Area of Focus**: - Manage inbound calls regarding billing inquiries - Outbound calls to collect payment on overdue balances - Manage and work salesforce cases related to billing...
-
Billing Specialist
hace 2 días
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: Tebra is looking for a Billing Specialist(s) that will perform various activities to support our company's accounting department and billing processes. **Your Area of Focus**: - Manage inbound calls regarding billing inquiries - Outbound calls to collect payment on overdue balances - Manage and work salesforce cases related to billing...
-
Procurement Specialist
hace 7 meses
Heredia, Costa Rica BAXTER A tiempo completo**This is where you save and sustain lives** At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You'll feel a sense of purpose throughout the organization, as we know our work improves outcomes for millions of patients. Baxter's products and therapies are found in...
-
Kn Global Services Her
hace 6 días
Heredia, Costa Rica Kuehne+Nagel A tiempo completoIf you wish to further develop your career with one of the most successful logistics organization, this is an excellent opportunity to join our team. - ** Your Role **:Specialist works providing operational support along with clerical tasks that aid the business operations. - ** Your Responsibilities**: - + Learn how to develop the processes into the...
-
Internal Enablement Training Specialist
hace 7 horas
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: Tebra is transforming healthcare information technology to increase practice efficiency and improve patient outcomes. We provide independent practices with digital tools and support to thrive in a new era of healthcare. We believe that how you start something is how you finish and the initial training any Customer Success member goes...
-
Implementation Specialist
hace 4 días
Heredia, Costa Rica Kareo A tiempo completoThe Position Implementation Specialist What We Need An **Implementation **Specialist** to help onboard and support our customers during Implementations. Your Area of Focus - Be the single point of contact owning the customer’s success during this critical time in the customer’s life-cycle and will assertively drive action to ensure that success -...
-
Account Specialist
hace 4 días
Heredia, Costa Rica Kareo A tiempo completoThe Position Account Specialist What We Need An **Account **Specialist** to help onboard and support our customers during Implementations. Your Area of Focus - Be the single point of contact owning the customer’s success during this critical time in the customer’s life-cycle and will assertively drive action to ensure that success - On-board our new...
-
Specialist, Implementation
hace 7 meses
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: An Implementation Specialist to help welcome, coordinate and set expectations for our customers during their first experiences with Tebra. **Your Area of Focus**: - Own end-to-end onboarding experience for new customers; involves leading a series of milestone onboarding calls over a 60-day period* - Embrace a sense of ownership over the...
-
Implementation Specialist
hace 7 horas
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: An Implementation Specialist to help onboard and support our customers during Implementations. **Your Area of Focus**: - Act as a "project manager" and single point of contact owning the customer's success during this critical time in the customer's life-cycle and will assertively drive action to ensure that success - On-board our new...
-
Account Specialist
hace 7 meses
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: As an Account Specialist, you will be the main point of contact to small businesses within the Tebra direct practice customer base. You will operate in a scaled account management model, where you will have a priority list of accounts to reach out to at any given time. You will proactively connect with customers for a variety of reasons;...
-
Implementation Specialist
hace 2 días
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: An Onboarding Specialist to help welcome, coordinate and set expectations for our customers during their first experiences with Tebra. **Your Area of Focus**: - Welcome new customers and provide the first critical experience to new customers - Provide superior customer service when engaging with the customer; create engaging and...
-
Specialist (Fp&a)
hace 7 horas
Heredia, Costa Rica BAXTER A tiempo completo**This is where you save and sustain lives** At Baxter, we are deeply connected by our mission. No matter your role at Baxter, your work makes a positive impact on people around the world. You'll feel a sense of purpose throughout the organization, as we know our work improves outcomes for millions of patients. Baxter's products and therapies are found in...
-
Payroll Specialist
hace 2 días
Heredia, Costa Rica LSEG (London Stock Exchange Group) A tiempo completoRole Responsibilities & Key Accountabilities: - Resolves complex payroll queries with employees and stakeholders using advanced oral and written communication skills (including English fluency; fluency in other languages may be required depending on region and role) - Assists payroll specialists in all countries. - Reconciles 3rd party payments. - Resolves...
-
Infrastructure Specialist
hace 7 meses
Heredia, Costa Rica IBM A tiempo completoIntroduction The infrastructure running industries likes transportation, energy, insurance, banking or healthcare is quickly changing as the world’s relationship with technology evolves. Companies have more choices than ever before between on-premise, off-premise, or a hybrid approach. Our Infrastructure Specialists are responsible for keeping up with...
-
Implementation Specialist
hace 7 horas
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: Implementation Specialists are responsible for managing the initial customer onboarding experience and all of the tasks necessary to setting our customers up for success. The onboarding process requires you to be proactive and effective in communicating with our customers. You will manage multiple projects at once, so superior...
-
Customer Retention Specialist
hace 7 meses
Heredia, Costa Rica Tebra A tiempo completo**About the Role**: As Customer Retention Specialist for the Loyalty Team, you will take inbound requests from customers requesting to cancel, identify key issues in customer satisfaction and develop solutions to retain the business. You will analyze quantitative and qualitative customer metrics to identify early indicators of possible cancellations and make...
-
Intake Specialist
hace 1 semana
Heredia, Costa Rica Virtual Staffing LLC A tiempo completo**Description**: A legal Intake Specialist receives and qualifies new and prospective clients for law firms. They are responsible for managing the processes of onboarding new clients and evaluating incoming streams of claims and potential clients. **Job Tasks**: - Outbound & Inbound Calling (Cold Calling) - Qualify and Signing up potential clients - Send...