Healthcare Specialist

hace 2 meses


San Francisco, Heredia, Costa Rica Auxis A tiempo completo

Job Summary:

The Clinical Review 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. The role will communicate with third-party payors to resolve discrepancies prior to billing and accurately document all communications and actions taken on the account in accordance with policies and procedures.

**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

**Requirements**:

English - Spanish Language (Oral and writing 85% or higher), (B2+ or above) - Must have a high school diploma or in progress to complete high school - At least 1 year of experience in Customer Service positions - Strong customer service skills - Excellent communication skills - Ability to work independently and collaboratively - Attention to detail - Comfortable multitasking in a high volume/high demand environment - Good presentation and a polite, tactful, and friendly character



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

    Job Title: Healthcare Onboarding SpecialistWe are seeking a skilled and experienced Healthcare Onboarding Specialist to join our team at Experian. This is a permanent home-based role in Costa Rica.About the RoleThe successful candidate will report to Experian Health and be responsible for managing the setup of clients, users, products, and payers based on...


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

    At Experian, we're committed to creating a better tomorrow for our clients and customers. As a Healthcare Reimbursement Specialist, you'll play a vital role in ensuring that our clients receive accurate and timely reimbursement for their healthcare services.We're seeking an experienced professional with a strong background in managed care claims and appeals....


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

    About the RoleWe are seeking a skilled Senior Healthcare Reimbursement Specialist to join our team at Auxis. As a key member of our operations team, you will play a vital role in ensuring timely reimbursement to our clients and leading provider of healthcare services.This is a dynamic position that requires strong analytical and communication skills, as well...


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

    Job Title: Healthcare Appeals SpecialistAbout the Role:Experian is seeking a skilled Healthcare Appeals 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.Key Responsibilities:Implement a process for...


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

    About Us: At Experian, our mission is to simplify healthcare for all by leveraging data-driven insights. We strive to create a diverse and inclusive work environment where collaboration, innovation, and accountability thrive.Job Summary: As a Healthcare Reimbursement Specialist, you will play a critical role in monitoring contractual allowances, analyzing...


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

    About ExperianExperian is a leading healthcare technology company dedicated to simplifying the complex world of healthcare. Our mission is to use data-driven insights to improve patient outcomes and reduce administrative burdens.Job SummaryWe are seeking an experienced Healthcare Reimbursement Specialist to join our team in [location]. This role will be...


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

    Job OverviewWe are seeking a highly skilled Healthcare Onboarding Specialist to join our team at Experian. This is a permanent home-based role in Costa Rica, offering a unique opportunity to work with a global leader in the healthcare revenue cycle industry.About the RoleAs a Healthcare Onboarding Specialist, you will be responsible for managing the setup of...


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

    About the Role:As a Healthcare Insurance Support Specialist at Auxis, you will play a crucial part in providing exceptional support to one of our largest accounts and leading providers of healthcare services. With over 959 hospitals and 2979 physician practices serving more than 50 million patient encounters annually, this is an opportunity to make a...

  • Data Analyst

    hace 1 mes


    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    Job Summary:The Data Analyst - Healthcare Discrepancy Specialist is responsible for supporting all activities related to government logging and discrepancy analysis function which includes verifying the accuracy of calculated discounts and analyzing discrepancies to determine root cause and resolution steps.Key Responsibilities:Monitor and resolve unpaid...


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

    About the RoleWe are seeking a highly skilled Healthcare Appeals Specialist to join our team at Auxis. In this role, you will be responsible for pursuing additional payment on open appeals through various means of communication, including telephonically, online, or via payment package processes with payers and patients.Key Responsibilities:Pursue additional...


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

    Experian Career OpportunityWe are seeking a highly skilled Data-Driven Healthcare Support Specialist to join our team. As a key member of our customer support team, you will play a crucial role in providing exceptional support to our clients and customers.About the Role:The Data-Driven Healthcare Support Specialist will be responsible for troubleshooting...


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

    **Job Overview**: We are seeking a highly skilled Technical Support Specialist to join our Experian Healthcare team. This is a permanent home-based role in Costa Rica, offering a unique opportunity to work with a leading provider of healthcare solutions.**Salary:** $45,000 - $65,000 per annum**Job Description:** As a Technical Support Specialist, you will be...


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

    Auxis is seeking a skilled Healthcare Insurance Specialist to join our team in providing exceptional customer service and support. As an integral part of our team, you will play a crucial role in ensuring the accuracy and efficiency of insurance policy updates and reinstatements.About the Role:You will work closely with our clients to resolve account-related...


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

    About the RoleWe are seeking a skilled Healthcare Appeals Specialist to join our team at Experian. In this role, you will be responsible for monitoring contractual allowances, analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance.Key ResponsibilitiesImplement processes for identifying under-allowed claims...


  • 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...

  • 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

    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...

  • Appeals Specialist

    hace 2 meses


    San Francisco, Heredia, Costa Rica Auxis A tiempo completo

    About the RoleWe are seeking an Appeals Specialist to join our team at Auxis, a fast-growing business process outsourcing provider. As an appeals collector for a leading healthcare services provider, you will monitor the claims process to ensure timely reimbursement to the provider, keeping medical expenses fair to patients.Responsibilities:Pursue additional...


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

    About ExperianExperian is a pioneering healthcare technology company dedicated to simplifying the complex world of healthcare. Our mission is to harness data-driven insights to create a more streamlined and efficient system that benefits both consumers and healthcare professionals.


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

    Job Overview">We are seeking a highly skilled Healthcare Revenue Cycle Management Upgrade Specialist to join our team at Experian. This is a permanent, home-based role in Costa Rica.">About the Role">The successful candidate will work with main clients to provide on-site and remote project management and support for Experian Health product upgrades.">You...