Claims Resolution Representative Hybrid Warrick, RI at Gainwell Technologies LLC

Warwick, Rhode Island, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Sep, 26

Salary

43500.0

Posted On

22 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Healthcare Policy Interpretation, Prior Authorizations, Third-Party Liability, Manual Pricing, Data Entry, Microsoft Excel, Microsoft Word, Microsoft Outlook, Time Management, Organizational Skills, HCPC Coding, CPT Coding, Coordination Of Benefits, Research, Report Preparation

Industry

IT Services and IT Consulting

Description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary Perform routine but moderately complex tasks that are related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalates only the most complex issues to immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections and data entry. Performs other duties as assigned. Involved in the training of new employees and may take the lead in areas of expertise.Your role in our mission Resolve suspended medical claims utilizing Medical Assistance Policy. Entry and/or approval of medical Prior Authorizations. Entry and maintenance of third-party insurance information to facilitate coordination of benefits and benefit recovery. Identification of accident-related claims. Identification of accident-related claims Research, entry, and maintenance of HCPC and CPT codes; Entry of nursing home, hospital, federally qualified health centers and ambulatory surgical center rates. What we're looking for Typically requires 3 – 5 years general experience, or equivalent combination of experience and college-level education. Healthcare, insurance, or third-party billing experience helpful Self-motivated with excellent time management and organizational skills; ability to work independently. Experience with Microsoft Outlook, Word, and proficiency with Excel Ability to interpret healthcare policy, laws, and regulations. What you should expect in this role On-site environment located in Warwick, RI. Hybrid possible after training. #LI-Hybrid #LI-LS2 The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Responsibilities

Perform routine and moderately complex healthcare claims processing tasks, including prior authorizations and third-party liability research. Ensure all claims comply with state and federal regulations while resolving customer and management inquiries.