Medical Determination Specialist
Who We Are
Zion HealthShare is a nonprofit medical cost-sharing program that provides an organized structure for members to contribute toward each other's medical costs.
We offer individuals and organizations across the country an affordable alternative to insurance; this provides peace of mind.
Our goal is to be America's leading HealthShare. We strive to meet our members' needs on a personal level by following our core values : inclusive, transparent, simple.
Everything we do for our members is to ensure they feel respected and to let them know we truly care about their needs.
Position Summary :
Are you someone who holds either an MA or LPN that wants to work in a fun, fast paced environment with the flexibility to select from different shifts?
Then this maybe the perfect opportunity. You will play a vital role to our community by making important decisions for a broad spectrum of medical specialties and conditions.
These determinations are based on an established set of guidelines regarding what is eligible for payment. Your ability to work efficiently and in a team setting will be vital to the overall success of Zion HealthShare.
Essential Duties and Responsibilities :
- Evaluate all Medical Need Submissions received from members to determine eligibility (aka adjudicator) for sharing into medical expenses.
- Communicate effectively and consult with members, providers, and team members as necessary throughout the determination process.
- Keep members and providers informed and updated about medical needs through regular verbal and written communication.
- Act with a sense of urgency in making determinations on medical needs.
- Maintain HIPAA compliance and company compliance policies.
- Takes inbound and outbound phone calls from members and providers regarding questions or concerns with the eligibility determination.
- Providers support to email inbox management.
- Assists with requests and following up on obtaining medical records.
- Continuously strive to exceed member expectations ensuring a high level of member satisfaction.
- Provide recommendations to the Member Guidelines Committee as needed.
Required Skills and Abilities :
- Professional level of written and verbal communication that demonstrates directness, compassion, and empathy
- Microsoft Office Suite Proficiency
- Ability to read and interpret medical records
- Ability to work effectively within a team
- Sincere desire to help other people
- Time Management
- Attention to detail
Required Education :
Minimum Requirement - Utah Medical Assistant (MA) license
Experience preferred :
- Minimum of 3+ years relevant medical records and medical terminology experience
- Working knowledge of healthcare industry, policies, and guidelines
- Experience working with and interpreting medical bills, statements, receipts, and medical records
- Familiarity with HIPAA
- Experience or familiarity in working from a CRM (Customer Relationship Management) system
- Spanish Speaking
Physical Requirements :
- Sit for up to 8 hours a day and look at dual computer screens
- Type on a keyboard at a minimum of 45 WPM
Benefits :
- Medical, dental, and vision insurance
- 401(k) plan with company match
- Paid time off (PTO)
- Short-term disability insurance
- Life Insurance
- Paid holidays
Job Posted by ApplicantPro