HOME OFFICE
WHAT YOU'LL DO:
- Determines coverage for medical, dental, and vision procedures by studying provisions of the member’s health policy
- Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers, and other third partners
- Initiates investigation of questionable claims
- Resolves medical, dental, and vision claims and billing questions and issues by
- examining the summary of benefits
- contacting the carrier and/or the provider billing office to ensure the member is not being overcharged
- calculating out-of-pocket costs based on benefits
- initiating reimbursement requests with the carrier
- composing appeal letter
- Provides information on year-to-date deductible, copay, and coinsurance activity to team members
- Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
- Protects claimant information by following HIPAA guidelines
- Reports claim status updates in proprietary CRM and provides detailed information on each claim
WHO YOU ARE:
Our Navigation Operations is a fast-paced, dynamic, and growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers.
- Strong communication skills, both written and verbal
- Professional experience with both benefit plan interpretation, provider billing practices, and claim adjudication
- Strong demonstration of critical thinking and problem-solving skills
- Minimum of 2 years of experience as a medical claims specialist preferred
Expected hourly rate - $22-$25/HR
ABOUT RIGHTWAY:
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
