Talent.com
Provider Post Claim Resolution Representative - R3211-6334

Provider Post Claim Resolution Representative - R3211-6334

Idaho StaffingMeridian, ID, US
1 day ago
Job type
  • Full-time
Job description

Provider Resolution Specialist

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 role is located at our corporate headquarters in Meridian, ID and offers a hybrid work schedule.

We are looking for a Provider Resolution Rep with :

  • 3+ / 4+ years' health industry or related experience.

What a day as a Provider Resolution Specialist I 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
  • As of the date of this posting, a good faith estimate of the current pay range is $23.11 to $35.77. The position is eligible for an annual incentive bonus (variable depending on company and employee performance. The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer. We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical / dental / vision / pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program. We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

    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.

    Create a job alert for this search

    Claim Representative • Meridian, ID, US

    Related jobs
    • Promoted
    Mental Health Therapist

    Mental Health Therapist

    SonderMind CareersKuna, ID, US
    Full-time
    SonderMind is a leading mental health care platform revolutionizing therapy services by empowering licensed mental health therapists to deliver exceptional care with cutting-edge, AI-powered tools....Show moreLast updated: 30+ days ago
    • Promoted
    Specialist, Appeals & Grievances

    Specialist, Appeals & Grievances

    Idaho StaffingBoise, ID, US
    Full-time
    Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requ...Show moreLast updated: 11 days ago
    • Promoted
    Start Your Career with US Army! Full Benefits Packages!

    Start Your Career with US Army! Full Benefits Packages!

    United States ArmyIdaho City, ID, US
    Part-time +1
    Start You Career! Full Benefits Packages! Overview : Join the U.Army and secure a bright future for your family.As a dedicated member of our forces, you'll not only serve your country with honor but...Show moreLast updated: 10 days ago
    • Promoted
    Travel Physical Therapist (PT) - $2,436 per week in Emmett, ID

    Travel Physical Therapist (PT) - $2,436 per week in Emmett, ID

    AlliedTravelCareersEmmett, ID, US
    Full-time
    AlliedTravelCareers is working with talent4health to find a qualified Physical Therapist (PT) in Emmett, Idaho, 83617!.Talent4Health is the most candidate-centric agency in the industry.Talent4Heal...Show moreLast updated: 30+ days ago
    • Promoted
    Telemedicine Physician

    Telemedicine Physician

    QuickMDKuna, ID, US
    Full-time
    QuickMD is a leading telemedicine provider, delivering high-quality virtual care across 44 states.Since our founding in 2019, we have helped more than 100,000 patients access essential medical trea...Show moreLast updated: 30+ days ago
    • Promoted
    Serve Your Community - Part Time Positions!

    Serve Your Community - Part Time Positions!

    United States ArmyIdaho City, ID, US
    Part-time +1
    Serve Your Community! Part Time Positions! Overview : Embark on a rewarding journey with the U.Army and make a difference in your community! As a valued member of our forces, you'll have the opportu...Show moreLast updated: 10 days ago
    • Promoted
    Short Range Air Defense System Repairer

    Short Range Air Defense System Repairer

    United States ArmyIdaho City, ID, US
    Full-time
    As a Short Range Air Defense System Repairer, you’ll be one of the most technically and tactically proficient Soldiers in the world. You’ll supervise and perform maintenance and repair on the Army’s...Show moreLast updated: 10 days ago
    • Promoted
    Unit Supply Specialist

    Unit Supply Specialist

    United States ArmyIdaho City, ID, US
    Full-time
    ELIGIBLE FOR UP TO A $20K SIGNING BONUS.Talk to your recruiter for details.As a Unit Supply Specialist, you’ll be responsible for supervising and maintaining all Army supplies and equipment.You’ll ...Show moreLast updated: 10 days ago
    • Promoted
    Travel Physical Therapist - $1,996 per week

    Travel Physical Therapist - $1,996 per week

    Nationwide Therapy GroupEmmett, ID, US
    Full-time
    Nationwide Therapy Group is seeking a travel Physical Therapist for a travel job in Emmett, Idaho.Job Description & Requirements. Nationwide Therapy Group Job ID #33816652.Pay package is based on 8 ...Show moreLast updated: 3 days ago
    • Promoted
    Earn Money Playing Games, Answering Surveys & Testing Apps

    Earn Money Playing Games, Answering Surveys & Testing Apps

    AttaPollKuna, ID, US
    Full-time
    Get paid to answer surveys, play games, test apps, and do tasks.Make extra money on your phone and instantly cash out to PayPal, Revolut, or with gift cards from $3.Show moreLast updated: 4 days ago
    • Promoted
    CA WC Claims Specialist (SIP)

    CA WC Claims Specialist (SIP)

    CorVelBoise, ID, US
    Full-time
    The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, un...Show moreLast updated: 1 day ago
    • Promoted
    Physical Therapist

    Physical Therapist

    Delta CompaniesEmmett, ID, US
    Full-time
    Setting : Outpatient, Orthopedics.Compensation : $1,740 - $2,040 estimated weekly pay.Start : ASAP | open to 1-2 months out. Duration : 13 weeks | potential to extend .Benefits : Blue Cros...Show moreLast updated: 2 days ago
    • Promoted
    Travel Physical Therapist (PT) in Emmett, ID

    Travel Physical Therapist (PT) in Emmett, ID

    AlliedTravelCareersEmmett, ID, US
    Full-time +1
    AlliedTravelCareers is working with Delta Healthcare Providers to find a qualified Physical Therapist (PT) in Emmett, Idaho, 83617!. Setting : Outpatient, Orthopedics .Compensation : $1,740 - $2,040 ...Show moreLast updated: 30+ days ago
    • Promoted
    Travel CT Tech - $2,785 per week in Emmett, ID

    Travel CT Tech - $2,785 per week in Emmett, ID

    AlliedTravelCareersEmmett, ID, US
    Full-time
    AlliedTravelCareers is working with talent4health to find a qualified CT Tech in Emmett, Idaho, 83617!.Night Shifts X 12Hrs ( May include Nights, weekends, swing shifts ).Talent4Health is the most...Show moreLast updated: 3 days ago
    • Promoted
    Clinical Social Worker - Fee For Service

    Clinical Social Worker - Fee For Service

    ThriveworksMelba, ID, US
    Full-time
    Thriveworks is currently seeking Licensed Clinical Social Workers to provide a mix of telehealth and face-to-face sessions in Meridian, ID. At Thriveworks, we’re not just growing a practice&md...Show moreLast updated: 2 days ago
    • Promoted
    Patriot System Repairer

    Patriot System Repairer

    United States ArmyIdaho City, ID, US
    Full-time
    Talk to your recruiter for details.As a Patriot System Repairer, you’ll become one of the most highly trained Soldiers in the world. You’ll use your advanced skills to perform field-level maintenanc...Show moreLast updated: 10 days ago
    • Promoted
    Restaurant Delivery - Flexible Onboarding

    Restaurant Delivery - Flexible Onboarding

    DoorDashEmmett, ID, United States
    Full-time +1
    DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day. As a Dasher, you’ll stay busy with a variety o...Show moreLast updated: 6 days ago
    • Promoted
    Share Your Opinions. Earn Rewards.

    Share Your Opinions. Earn Rewards.

    Opinion EdgeKuna, ID, US
    Full-time
    Join Opinion Edge today and get paid for your insights! Take short surveys on the topics that matter to you and earn rewards for every completed survey. Sign up now and start turning your voice into...Show moreLast updated: 4 days ago