Medical Needs Processor

We are seeking a highly organized and customer-oriented Needs Processor & Auditor to join our team! This role requires a combination of research acumen, attention to detail, and exceptional customer service skills. As a key member of our organization, you will be responsible for processing medical needs accurately, conducting thorough audits to ensure compliance with regulations and policies, and providing excellent service to our clients and healthcare providers.

This role requires excellent communication skills, attention to detail, and the ability to multitask in a fast-paced environment.

• →Review and process medical needs submitted by members or providers promptly and accurately.

• →Verify the accuracy and completeness of needs information, including patient demographics, diagnoses, procedures, and billing codes when available.

• →Ensure compliance with insurance policies and industry standards.

• →Investigate and resolve any discrepancies or issues related to needs submissions.

• →Conduct comprehensive medical needs audits to identify errors, discrepancies, or fraudulent activities.

• →Analyze needs documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies.

• →Research complex medical billing and coding issues to support needs processing and audit activities.

• →Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate needs adjudication.

• →Provide recommendations for improving needs submission procedures and enhancing reimbursement accuracy.

• →Serve as members' primary point of contact regarding needs inquiries and resolution.

• →Respond promptly to customer inquiries and concerns with professionalism and empathy.

• →Collaborate with cross-functional teams to address customer issues and ensure timely resolution.

• →Maintain accurate records and ensure compliance with HIPAA regulations and company policies.

• University or midterm student; experience in health care support related fields

• Strong knowledge of medical terminology, medical coding, and insurance billing practices;

• Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines;

• Exceptional attention to detail and accuracy in data entry and documentation;

• Effective verbal and written communication skills with a customer-centric approach;

• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment;

• Excellent verbal, written and interpersonal communication skills;

• Must be self-motivator and self-starter;

• Exceptional listening and analytical skills;

• Solid time management skills;

• Ability to multitask and successfully operate in a fast-paced, team environment;

• Must adapt well to change and successfully set and adjust priorities as needed;

• Salesforce Experience
• Google Suite Experience
• Claims Management Software experience

If you have a passion for connecting with people and making an impact in the healthcare industry, we'd love to hear from you!