Medical Claims Processor Job at Vanguard Group Staffing, Inc., New York, NY

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  • Vanguard Group Staffing, Inc.
  • New York, NY

Job Description

Long Term Temporary, Possible Temporary- to -Direct Hire Medical Billing/Claims Coordinator - Monday through Friday, 9am to 5pm, Fully On-Site.

  • Communicate via telephone and written correspondence with providers, members, attorneys, and collection agencies to resolve balance billing/fee negotiation inquiries.
  • Handle large call volume.
  • Negotiate and resolve balance billing inquires, negotiate fees and discounts for members with nonparticipating providers to reduce out of pocket expenses.
  • Analyze correspondence; verify member eligibility, claim history and coordination of benefits.
  • Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover money.
  • Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices.
  • Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner.
  • Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network.
  • Perform additional duties and projects as assigned by management.

Job Tags

Temporary work, Monday to Friday,

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