Claims Research & Resolution Professional

We’re seeking dedicated individuals to join our dynamic team at VFS. Our Claims Research & Resolution Professionals are responsible for conducting root cause analyses of claims data to track and trend claims denials, underpayments, claims errors, and provider education. The Claims Research & Resolution Professionals will engage with providers, one-on-one or in group settings, to educate them on appropriate claims submission processes and requirements, coding updates, and common billing errors to reduce claims denials and assist providers in getting reimbursed timely and accurately.

The Claims Research & Resolution Professional’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

This position is a contingent worker position through Vision Financial Services at our client United Healthcare.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Your role:

· Conducts training with providers or groups of providers and their staff on claims denials, and/or underpayments based on trended provider claims issues and common claims errors.

· Partners with Provider Education & Outreach Representatives to ensure prompt resolution of provider inquiries.

· Assists with the development of provider bulletins or training documents related to common claims issues and billing inaccuracies.

· Attends association and/or state lead meetings where providers can ask questions specific to claims.

· Monitors providers post-training to ensure the issues causing the denials are resolved.

Your benefits:

- Competitive compensation package

- Health insurance benefits with optional life, vision, and dental coverage*

- Six paid holidays, two paid floating holidays, and paid vacation*

- Collaborative and supportive team environment

- Free training provided virtually from home

Details at a glance:

Position Type: Full-time (40 hours/week)

Location: Hybrid - majority Remote with occasional travel.

Classification: Non-Exempt | Reports to: Claims Manager, Provider Services

You have:

Required Qualifications

· Must reside in the state of Indiana

· Must be able to commute to the Indianapolis office and / or provider locations with a potential in-office work requirement on occasion.

· 2-3 years working in the healthcare industry such as in a provider setting or insurance company.

· 2-3 years of medical claims experience such as billing, claims processing, or provider customer service.

· 1-2 years of customer-facing experience.

· General knowledge of claims coding and/or dispute resolution.

· Beginning to intermediate experience in Microsoft Office applications.

Preferred Qualifications

· Highschool/GED or equivalent

· Experience with Indiana Medicaid

· Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.