Description

NOTE: THIS POSITION HAS THE ABILITY TO WORK REMOTELY UNTIL FURTHER NOTICE!

Innovista Health Solutions is an Illinois-based service organization with management services operations in Illinois and Texas. We are currently looking for a Claims Examiner in our Oak Brook, IL office. At Innovista, we believe that positive forward movement in today’s uncertain healthcare market stems from the combination of innovative programs and dedicated people. Join the Innovista team and lead the charge to a better, more efficient healthcare system.

JOB SUMMARY:

Analyze claims and approve or deny payment. Provide expertise on claims processing issues to co-workers and management.

DUTIES AND RESPONSIBILITIES:

• Approve or deny claims for payment by ensuring the payment is correct, verifying the proper authorizations were submitted, and resolving any system hold codes.
• Resolve reoccurring provider or member issues by identifying trends and recommending solutions to management.
• Capture COB savings by coordinating payments of claims between insurance companies when more than one insurance company is involved.
• Resolve claims issues received from the Customer Services department by researching claim situations and providing timely responses.
• Enhance department productivity by recommending improvements to work flow processes and organizational structure.
• Ensure the completeness and accuracy of Standard operating procedures by providing feedback to the department manager on procedures that require documentation or additional detail.
• Contribute to team effort by accomplishing the related goals and results as determined by the Claim Manager.
• Maintains all necessary levels of member/patient privacy in accordance with HIPAA standards.
• Perform related duties as required.

Requirements

• Associate’s degree or equivalent experience required
• At least 2-3 years of relevant professional experience, including claims processing
• Knowledge of claims and processes in Commercial, Medicare, and Medicaid health plan/TPA organization.
• Extensive knowledge of CPT 4, HCPCS and ICD-10 coding.
• Knowledge of Medical terminology J7J9J2:J6
• Demonstrate excellent organizational skills.
• Demonstrate effective verbal and written communication skills.
• Demonstrate analytic skills when problem solving.
• Proficient in MS Office Applications and ability to learn department and job specific software systems.
• Demonstrate high attention to detail and a high degree of accuracy
• Able to commit to Innovista’s corporate mission and values
• Able to switch priorities in a positive and effective manner when directed by Company leadership.
• Able to effectively communicate technical concepts with team members and basic business concepts with team members and internal customers.
• Must be comfortable working with and troubleshooting the Microsoft and Mac OS operating systems.
• Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor

BENEFITS:

Innovista is dedicated to hiring passionate individuals who embody our core values: integrity, determination, and teamwork. We recognize the importance of work-life integration and seek to provide our employees with competitive benefits, which include:

• Comprehensive health plan options, dental, and vision coverage subsidized by Innovista
• Opportunity to work from home, based on position and manager discretion
• Company-paid benefits, such as short- and long-term disability, employee life, and AD&D
• Discretionary bonus
• 401(k) with company match
• Opportunity for career advancement and growth
• Flex time options may be available

Please note: we do not post salary ranges. Salary ranges posted on other sites are not tied to our labor market specifications and are not relevant.