WHO YOU ARE:

Our Navigation Operations is a fast-paced, dynamic, and growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers.

• Strong communication skills, both written and verbal
• Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
• Strong demonstration of critical thinking and problem-solving skills
• Bachelor’s degree in health sciences or related field and minimum of 2 years of experience as a medical claims specialist preferred

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:
1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
4) We cultivate grit
Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.

• Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy
• Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
• Initiates investigation of questionable claims
• Resolves medical, dental, and vision claims and billing questions and issues by
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• examining the summary of benefits

• contacting the carrier and/or the provider billing office to ensure the member is not being overcharged
• calculating out-of-pocket costs based on benefits
• initiating reimbursement requests with the carrier
• composing appeal letter
• Provides information on year-to-date deductible, copay, and coinsurance activity to team members
• Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
• Protects claimant information by following HIPAA guidelines
• Reports claim status updates in proprietary CRM and provides detailed information on each claim