Billing and Claims Specialist

Job description

This role is located in our Denver Tech Center Office. This is not a remote position. WHAT YOU'LL DO: - Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy - Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners - Initiates investigation of questionable claims - Resolves medical, dental, and vision claims and billing questions and issues by - examining the summary of benefits - contacting the carrier and/or the provider billing office to ensure the member is not being overcharged - calculating out-of-pocket costs based on benefits - initiating reimbursement requests with the carrier - composing appeal letter - Provides information on year-to-date deductible, copay, and coinsurance activity to team members - Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner - Protects claimant information by following HIPAA guidelines - Reports claim status updates in proprietary CRM and provides detailed information on each claim WHO YOU ARE: Our Nav...