Healthcare Claims Specialist

hace 21 horas


San Francisco, Heredia, Costa Rica Experian A tiempo completo
Role Summary

We 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 Role
  • Implement process for identifying under-allowed claims using software and other available tools.
  • Reviews and analyzes EOBs for identified under-allowed claims.
  • Verifies applicable contract by reviewing EOB messages, patient ID card, and verifying member information for managed care plans.

You will utilize feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals, batch appeals by payer or network, CPT/HCPCS code combination, error type, or provider, compile and submit appeals, and monitor for proper reimbursement.

Requirements
  • High School completed and some university studies preferred.
  • Minimum of one to two years' experience working with managed care claims and appeals for healthcare professional services (physicians and other health care professionals).
  • Experience in a production environment desirable but comfort in such an environment is essential.

We offer a competitive salary of approximately $65,000 per year, based on experience, plus additional benefits including medical, dental, and vision insurance, 401(k) plan, and paid time off.

This is a great opportunity to work for Experian, a company that values diversity, equity, and inclusion. We strive to create a thriving, inclusive and diverse team where people love their work and love working together.



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