Medical Claims Resolution Specialist

hace 21 horas


San Francisco, Heredia, Costa Rica Auxis A tiempo completo

Job Summary

The Medical Claims Resolution Specialist will be responsible for reviewing prebill accounts that do not have an authorization on file, identifying discrepancies and communicating with third-party payors to resolve issues prior to billing. The specialist will accurately document all communications and actions taken on the account in accordance with policies and procedures.

Responsibilities

  • Work prebill accounts efficiently and effectively to resolve accounts with 'no auth numbers' and ALOS vs. authorized days variances
  • Report insurance denial trends identified during daily operational assignments
  • Identify problem accounts and escalate as appropriate
  • Contact facilities, physicians' offices, and/or insurance companies to resolve denials/appeals
  • Adhere to time and attendance policies, all policies and procedures, and participate in ongoing education and training as needed
  • Establish and maintain relationships with all customers

Skills and Qualifications

To be successful in this role, you should possess a high school diploma and at least one year of related experience. Key skills include:

  • Effective communication and interpersonal skills
  • Ability to work in a fast-paced environment and manage multiple tasks simultaneously
  • Strong analytical and problem-solving skills
  • Attention to detail and ability to perform basic mathematical calculations
  • Knowledge of organizational policies, procedures, and systems

Benefits and Opportunities

Auxis offers a dynamic and supportive work environment, with opportunities for growth and development. If you are a motivated and detail-oriented individual with a passion for medical claims resolution, we encourage you to apply for this exciting opportunity.



  • San Francisco, Heredia, Costa Rica Grupo Stt A tiempo completo

    About UsGrupo Stt is a leading management consulting and outsourcing firm focused on helping organizations achieve peak performance in their back-office operations.Salary and BenefitsOur base salary for this position is $635,000 colones, and we offer a bonus of $180,000 colones paid after 60 days. We also provide a monthly transportation subsidy of $30,000...


  • San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Job SummaryWe are seeking a Claims Resolution Specialist to join our team in Costa Rica. This is a permanent home-based role, and we require candidates to be highly motivated and results-driven.About ExperianExperian is a leading global information services company that helps businesses and consumers make informed decisions. We pride ourselves on creating a...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Auxis is a fast-growing business process outsourcing provider that supports leading healthcare services. This partnership serves 959 hospitals and 2979 physician practices, facilitating over 50 million patient encounters annually.As a Claims Resolution Associate at Auxis, you will analyze customer accounts to identify discrepancies between expected costs and...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Auxis is a fast-growing business process outsourcing provider seeking a highly skilled Healthcare Claims Resolution Specialist to support one of our largest accounts and leading provider of healthcare services.This esteemed organization serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually, making it a critical...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Auxis is a fast-growing business process outsourcing provider that supports leading healthcare services companies. As a Medical Claims Verification Specialist, you will play a critical role in ensuring the accuracy and timeliness of insurance policy updates in various databases.**Key Responsibilities:**Review patient accounts for accuracy prior to sending...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Estimate salary: $45,000 - $65,000 per year.About the RoleWe are seeking a skilled Medical Claims Reimbursement Specialist to join our team at Auxis. As an Appeals Underpayment Collector, you will play a critical role in ensuring timely reimbursement to healthcare providers, promoting fair medical expenses for patients.ResponsibilitiesTriage incoming appeals...

  • Medical Claims Auditor

    hace 2 meses


    San Francisco, Heredia, Costa Rica Experian A tiempo completo

    At Experian, we strive to simplify healthcare using data-driven insights. Our culture values openness, innovation, and accountability, making it an ideal place for a Medical Claims Auditor.The role involves monitoring contractual allowances, analyzing appeal opportunities with payers and networks, and reporting appeals performance. Key responsibilities...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job 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.As a Medical Insurance Claims Examiner, you will review...

  • Healthcare Specialist

    hace 2 meses


    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Auxis is seeking a highly skilled Healthcare Specialist to join our team in resolving pre-bill insurance claims.Job SummaryThis role involves reviewing pre-bill accounts for discrepancies, communicating with payors to resolve issues, and accurately documenting communications and actions taken. The ideal candidate will have excellent communication skills, be...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    **Job Summary:**We are seeking a skilled Healthcare Claims Specialist to join our team at Auxis. This role will involve reviewing customer accounts and identifying discrepancies between expected costs and payer payments, ensuring an efficient billing process for medical providers.**Responsibilities:Perform government discrepancy analysis and processes...


  • San Francisco, Heredia, Costa Rica Experian A tiempo completo

    Role SummaryWe are seeking a skilled Healthcare Claims Specialist to join our team. In this role, you will be responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.About the RoleImplement process for identifying under-allowed claims using software and other...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Role Summary:You will be working for Auxis to provide support to a leading healthcare services provider. This provider serves a large number of hospitals and physician practices with numerous patient encounters annually.Key Responsibilities:As a Tri-Care Clerk, you will review customer accounts and identify discrepancies between expected costs and payer...


  • San Francisco, Heredia, Costa Rica People Working Corp A tiempo completo

    About People Working CorpOur company specializes in consulting and outsourcing, with a presence in Heredia, Costa Rica. We are seeking a highly skilled Lead Collector and Resolution Specialist to join our team.Job SummaryThe Lead Collector and Resolution Specialist will be responsible for resolving outstanding claims and appeals in a timely manner, ensuring...


  • San Francisco, Heredia, Costa Rica People Working Corp A tiempo completo

    At People Working Corp, we are seeking a skilled Professional Appeals Resolution Specialist to join our team in Heredia, Costa Rica. In this role, you will be responsible for pursuing additional payment on open appeals through various means of communication with payers and patients.Key Responsibilities:Pursue timely payment and resolution of appeals by...


  • San Francisco, Heredia, Costa Rica Viant Medical A tiempo completo

    About the RoleWe are seeking a highly skilled Medical Device Sterilization Specialist to join our team at Viant Medical. In this critical role, you will be responsible for providing support to sterilization projects and programs.


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    **Job Summary:**Auxis is seeking a highly organized and detail-oriented Healthcare Insurance Claims Specialist to join our team. As a key member of our client's operations, you will play a vital role in ensuring the timely and accurate processing of insurance claims.About Auxis:We are a fast-growing business process outsourcing provider dedicated to...

  • Senior Appeals Specialist

    hace 3 semanas


    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job OverviewAuxis is a dynamic company that prioritizes employee growth and development, empowering you to advance your career. As a Senior Appeals Specialist, you will play a crucial role in resolving claims efficiently.ResponsibilitiesTriage incoming inventory for the appeals team, ensuring appeal criteria are metCompose technical denial arguments for...


  • San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    About AuxisAuxis is a dynamic and innovative organization seeking a highly skilled Pre-Bill Denial Claims Specialist to join our team.Job SummaryWe are looking for a detail-oriented and results-driven professional to work on pre-bill accounts, resolving discrepancies and communicating with third-party payors. The ideal candidate will have excellent...


  • San Francisco, Heredia, Costa Rica Viant Medical A tiempo completo

    Job Overview:Viant Medical is seeking an experienced Strategic Human Resources Business Partner to support our Costa Rica location. As a key member of the HR team, you will play a vital role in shaping the company's human resources strategy and delivering exceptional results.About Us:Viant Medical is a leading manufacturer of medical device products for...


  • San Francisco, Heredia, Costa Rica Abbvie A tiempo completo

    Job Overview    We are seeking a highly skilled Complaint Resolution Specialist to join our team at Abbvie. In this role, you will be responsible for reviewing complaint records to ensure global requirements are met.Responsibilities    Key responsibilities of the Complaint Resolution Specialist include investigating and documenting non-medical...