Job Description:
Blue Cross of Idaho is seeking a Provider Resolution Specialist. This role acts as a primary investigator for researching, analyzing and responding to provider inquiries and appeals within contractual requirements and plan guidelines.
This will be a hybrid position following training. You must reside in the Treasure Valley area in order to be considered.
We are looking for a Provider Resolution Rep with:
- 3 years' health industry or related experience.
What your day may look like:
- Interpret provider contracts ensure the alignment with processes and procedures.
- Engage with and educate providers regarding their fee schedules, claims processing and contractual requirements while maintaining a collaborative relationship.
- Review medical records and other documentation to ensure all required information is included to make a case determination.
- Review the correct application of ICD-10, CPT, HCPCS and other medical coding guidelines.
- Review, process and adjust claims for all lines of business.
- Perform other duties and responsibilities as assigned.
Additional skills we are looking for:
- Business writing
- Medical Terminology
- Coding certifications or familiarity with current medical coding guidelines
- Claims processing or related experience
- Experience with contract language
Reasonable Accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
