Insurance Research & Resolution Representative 1 / 562

Occupation:Technical Customer Service Position Description:The Research and Resolution Representative 1 is responsible for analyzing and assisting with handling claims appeals and questions to ensure appropriate resolution. MAJOR RESPONSIBILITIES: 1. Research, analyze, and resolve claim appeals from clients, patients, and providers through effective use of provider contract rates/fee schedule reimbursement considering products and contract association as it pertains to state specific legislation; including discussion with leased network affiliates and regional network development staff to bring claim dispute to 100% resolution. 2. Utilize the Repricing User Manual/Guide, AMA medical/data resources, and client's product & services for effective claim appeal results. 3. Interact as needed on departmental and multiple office client resolution task forces in addition to conference calls with clients, account managers and providers as needed. 4. Assist with supervisor’s calls and priority claim issues as requested. 5. Reprice and/or adjust facility and professional claims/appeals as needed. 6. Maintain department standards for production, accuracy and turnaround time for responsible book of business. 7. Compile written correspondence to clients including use of form letters as well as composing issues specific letters. 8. Provide turnaround reporting on a weekly basis and manage employee assigned accounts during employee transitions.9. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.Qualifications:• Bachelor’s degree or equivalent experience• Minimum 1 year of healthcare industry experience including or in addition to minimum 1 year of experience in a customer service environment • PPO contract experience and knowledge of CPT; ICD9; RBRVS, and HCPCS codes• Ability to analyze, research and resolve complex issues• Communication skills and knowledge of medical terminology• Knowledge of CPT, RVS, ICD-9 • Ability to use computer software and office equipment related to job responsibilities• Knowledge of EDI processes Location: Naperville, IL 60563 Job Status/Type: Full Time, Employee Career Level: Experienced (Non-Manager) Job RefCode: 562