Accounts Payable Provider Reimbursement Specialist - Remote, Nationwide

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Accounts Payable Provider - Reimbursement Specialist is responsible for investigating and processing appeals and grievances received by veterans or providers. This is a challenging role with serious impact, Specialist work collaboratively with other internal and external functional areas and stakeholders as necessary to resolve the case within the allocated timeframes.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

Analyze/research/understand how a claim was processed and why it was denied Obtain relevant medical records to submit appeals or grievance for additional review, as needed Leverage appropriate resources to obtain all information relevant to the claim Identify and obtain additional information needed to make an appropriate determination Obtain/identify contract language and processes/procedures relevant to the appeal or grievance Work with applicable business partners to obtain additional information relevant to the claim (e.g., Network Management, Claim Operations, Enrollment, Subrogation) Determine whether additional appeal or grievance reviews are required (e.g., medical necessity), and whether additional appeal rights are applicable Determine where specific appeals or grievances should be reviewed/handled, and route to other departments as appropriate

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

High school education or equivalent experience 2+ years of experience processing medical and or dental claims 1+ years of experience with PCs and Microsoft office, including Outlook (calendar management, sending correspondence), Word (drafting, sending and saving documents), Excel (basic formulas, creating and sending spreadsheets) and Power Point (creating, sending and saving presentations) Ability to work independently Exceptional time management skills Ability to create professionally written emails to providers Exceptional phone etiquette skills Superior Customer Service

Preferred Qualifications

Applies knowledge/skills to a range of moderately complex activities Demonstrates great depth of knowledge/skills in own function Sometimes acts as a technical resource to others in own function Proactively identifies solutions to non-standard requests Solves moderately complex problems on own Works with team to solve complex problems Plans, prioritizes, organizes, and completes work to meet established objectives. May coordinate work of another team member All employees working remotely will be required to adhere to Hiring Company’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. Hiring Company complies with all minimum wage laws as applicable. In addition to your salary, Hiring Company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with Hiring Company, you’ll