Healthcare Consultant 1

Okemos, MI | 12 Months

Post Date: 11/17/2017 Job ID: 7862092 Industry: Healthcare


All candidates need to be tested on Microsoft Office package, and scores attached to resume before submitting. Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. The Candidate should have solid Excel knowledge. The Candidate should have the ability to quickly learn and adapt to a new claim processing system.

Additional Job Details:

Must have knowledge of CPT Codes and ICD9/ICD10 codes. Processing experience for Office Visits, Labs, X-rays, Surgeries, Physical Therapy, Mental Nervous, In-patient Hspt., Out Patient Hspt., Vision. Work at home position. Candidates will use their personal computer to log into our Citrix environment. Will need high speed internet service. Processing will occur on a DOS Operating System (DG Claims System) Previous DOS or DG Experience would be a great asset. Minimal 200 claims per day while maintaining 99.8% Quality. This is a Self Funded business, there are no "cookie cutter" plans. Each plan is designed by the Clients needs.


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