Hello,

Please review below the job posting template:

Innova Solutions is immediately hiring for a Medical Claims Specialist

Position type: Full Time/Contract

Location: Darien Wisconsin 53114
Duration : 24 Months plus contract(possible converted into Full Time)

As a Medical Claims Specialist you will:

Job Description:

• This is a training position where the incumbent is learning to perform the following functions in a competent manner,Provide information and assistance needed to resolve problems experienced by practitioners in their various contractual relationships with HCSC, including but are not limited to claims, pricing, or contracts. Assure both parties understand the ?mechanics? of our relationship with these providers and that our various networks are working well for all involved.  Record activities in the specific format required by the region and management. Keep management advised of activities and needs accordingly.      Assist in providing training and continuing policy education on all facets of operations of HCSC to provider staff and others as needed.  Conduct provider servicing and assist in the development and distribution of appropriate training materials, etc., as needed.
• Submit reports on service and recruiting activities and other items as required by management.
• Respond to fee requests from providers.
• Provide ongoing development of database, reports and statistical analyses of managed care networks. Create, modify and maintain new and existing reports to provide accurate information for both internal and external reporting.
• Assist with the coordination and resolution of ?systemic? problems and claim issues. Identify problem and research the impact and origin for resolution.  Report problem to management and coordinate with either internal staff or the provider to assure resolution.
• Assist with the review of provider directories for the managed care networks.
• Develop and maintain a good working relationship with Core Services, Local Medical Directors, and other internal departments. Coordinate with various HCSC departments as required for the recruitment, servicing and retention of contracted providers.
• Establish working relationship with key facilities, physician groups, practice managers, IPAs, PHOs and other essential contacts. Serve as liaison between facilities or provider office staff and various internal departments.
• Maintain a high level of expertise in pricing arrangements, contract requirements/language, benefits, membership, claims processing, utilization review, etc.
• Process provider change forms. Maintain tickler system and verify that all changes have been made in the appropriate system.
• Prepare monthly reports and update provider databases as necessary. Assist with routine and special reporting requirements.
• Prepare and mail provider orientation packets, provider manuals and application packets.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

• JOB REQUIREMENTS:
  Bachelor Degree OR 4 years work experience in the health care/insurance industry
• 3 years experience in Network Management, Credentialing and/or Customer Service.
• Understanding of health care contracts, applications and products.
• Working knowledge of claims processing systems.
• 3 years experience utilizing a PC.
• Verbal and written communication skills.
• Teamwork and problem solving skills.
• Analytical and organizational skills.
• Organizational skills and experience meeting deadlines and working well under pressure.
• Familiar with provider reimbursement methods

PREFERRED JOB REQUIREMENTS:    

• Knowledge of health care policies, products and procedures.

Qualified candidates should APPLY NOW for immediate consideration!  Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.   ASK ME HOW.

Thank you!

Sumit Verma

Associate - Recruitment

Sumit.Verma@innovasolutions.com
 952-373-8983

PAY RANGE AND BENEFITS:

Pay Range*: $24 per hour on W2

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

• One of Largest IT Consulting Staffing firms in the USA - Recognized as #4 by Staffing Industry Analysts (SIA 2022)
• ClearlyRated Client Diamond Award Winner (2020)
• One of the Largest Certified MBE Companies in the NMSDC Network (2022)
• Advanced Tier Services partner with AWS and Gold with MS

Website: https://www.innovasolutions.com/

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any otherstatus protected by the statutes, rules, and regulations in the locations where it operates.  If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed.  Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities.   Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. * 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.