Reimbursement Review Services Representative-Provide Add
Full Time
Lexington, KY 40511
Posted
Job description
About Conduent:
Desired Experience: Claims, billing/coding experience
Duties include:
Job Track Description:
Job Track Description:
At Conduent, we value the health and safety of our associates, their families and our community. Under our current protocols, we do not require vaccination against COVID for most of our US jobs, but may require you to provide your COVID vaccination status, where legally permissible.
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.
You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Job Description:
**Conduent is hiring a Remote Reimbursement Review Services Representative-Provide Add**
Pay: $19/hr
Training hours: 8-5 EST M-F (2-4 weeks)
Work hours: Flexible but must work a 40 hour week
Must pass a background screen prior to employment
Must have a HS diploma or GED
Desired Experience: Claims, billing/coding experience
Duties include:
Nightly report from GCHP/Evips- EFT changes
- Member LOAs (M50 pends)
- Member non covered requests (M58 pends)
- Provider Add 2 day TAT workgroup – events sent from OPS team
- CCDs for vendor/provider updates
- Perfect Claim triage
- Creating/maintaining special match rules
- W9
- Move claims to EIN NOT FOUND queue and next day reject those claims so the claims are not counted in inventory.
- Receive W9s and add corporation to the system
- Add vendors/providers to support the claims
- Un-reject claims and set the clean date based upon the date the corporation’s W9 was received
- Push claims through Medi-Trac
Job Track Description:
- Performs business support or technical work, using data organizing and coordination skills.
- Performs tasks based on established procedures.
- In some areas, requires vocational training, certifications, licensures, or equivalent experience.
General Profile
- Ability to perform analytical and operational processes.
- Entry-level position with limited requirements for licenses, training, and certifications.
- Applies experience and skills to complete assigned work.
- Works within established procedures and practices.
- Works with a close degree of supervision.
Functional Knowledge
- Has basic skills in a range of processes, procedures and systems.
Business Expertise
- Understanding of how best teams integrate and work together to achieve company goals.
- Impacts a team, by example, through the quality service and information provided.
- Follows standardized procedures and practices.
- Receives close supervision and guidance.
- For consistency, methods and tasks are described in detail.
Leadership
- Has no supervisory responsibilities.
Problem Solving
- Ability to problem solve, self-guided.
- Has limited opportunity to exercise discretion.
Interpersonal Skills
- Exchanges information and ideas effectively.
Responsibility Statements
- Receives, processes, and ensures document classification are completed and transmitted to clients.
- May require outbound correspondence from the client to be processed.
- Receives documents from both electronic and hard copy forms for processing.
- Sorts, images, documents, files, and archives by form type.
- Identifies documents and their purpose; creating a database of information.
- Classifies documents based on contract requirements.
- Captures information based on client requirements.
- Verifies data from automated data extraction tools.
- Ensures transmission of processed data to the appropriate next level.
- Performs other duties as assigned.
- Complies with all policies and standards.
Job Track Description:
- Performs tasks based on established procedures.
- Uses data organizing and coordination skills to perform business support or technical work.
- Requires vocational training, certifications, licensures, or equivalent experience.
General Profile
- Has advanced and specialized expertise within a range of analytical or operational processes.
- Completes assignments and facilitates the work of others.
- May coordinate assignments beyond work area.
- Proposes improvements to processes and methods.
- Acts as a lead, coordinating the work of others, but is not a supervisor.
- Works autonomously within established procedures.
Functional Knowledge
- Has developed skills in a range of processes, procedures, and systems.
- Acts as a technical expert in some areas.
Business Expertise
- Understanding of how teams integrate and work best together to support the achievement of company goals.
Impact
- Impacts a team, by example, through the quality service and information provided
- Suggests work procedure and practice enhancements to improve efficiency.
Leadership
- Serves as a team lead.
- May allocate work to team members.
- Provides subject matter guidance to junior team members.
Problem Solving
- Provides solutions to atypical problems with little or no precedent.
Interpersonal Skills
- Clearly and effectively exchanges information and ideas.
Responsibility Statements
- Eliminates barriers to reimbursement and access for patients with complex and rare medical conditions.
- Builds relationships with patients, caregivers, HCSs, and Sales Teams to coordinate participation in the program.
- Researches available disease-specific information in the assigned region.
- Reports adverse events and product quality complaints, per policy.
- Advocates on behalf of the patient to problem-solve issues or obtain necessary information.
- Acquires and maintains subject matter expertise in rare or chronic diseases to ensure staff is providing the appropriate support and services.
- Coordinates training for new and existing team members.
- Conducts quality audits of calls and process flow documentation.
- Performs other duties as assigned.
- Complies with all policies and standards.
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.
At Conduent, we value the health and safety of our associates, their families and our community. Under our current protocols, we do not require vaccination against COVID for most of our US jobs, but may require you to provide your COVID vaccination status, where legally permissible.
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