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Third Party Representative

Company: Guidehouse
Location: Bessemer
Posted on: June 25, 2022

Job Description:


Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit .

Under general supervision and according to established policies and procedures, performs a variety of duties related to the Third Party Accounts recovery function of the MSO. Such duties may include, but are not limited to, the following:

Obtains claim statusReceives and reviews denialsPerforms data entry of charges into various carrier systemsResubmits reviews and corrected claims and supporting documentation as neededCommunicates with third party payors to obtain paymentCommunicates issues to management in a timely mannerPerforms other duties as requested by supervisor -Works support functions assigned by Supervisor/Manager (i.e.: claim edits, audit trails):
Works ETM returns, tickler returns and transfers daily Works claim edits and audit trails daily Work correspondence workbasket daily Works paper claims daily Weight x Rating = Score Responsibility Number 2 40% x = Processes denials from third party payors on patient accounts Works ETM views to obtain claim status on patient accounts Retrieves medical records needed to file appeals/ reviews to carriers c) Access payor websites for on-line keying of charges Research websites for specific coding policies (i.e., Encoder, CCI edits, CMS, etc.) Research accounts related to recoupments and refunds f) High dollar invoices addressed monthly Aged receivables addressed monthly Low dollar invoices addressed monthly Weight x Rating = Score Responsibility Number 3 30% x = Performs various data entry functions to correct information to accurately process charges Verifies and corrects insurance information in registration, visit and COB and refiles claims to correct carrier Posts appropriate contractual or other adjustments utilizing the payment posting function Enters various charge entry data utilizing the charge entry function Creates case and links appropriate invoices using case management function Weight x Rating = Score Responsibility Number 4 15% x = Provides responses in a timely manner by using available resources Receives incoming and outgoing calls and addresses billing inquiries from third party payors and MSO divisions Responds to work related emails in a timely manner Attends team meetings and other MSO functions Completes all required training and any ongoing educational needs

High School Diploma or equivalent. Good written and oral communication skills. Basic computer skills. -Preferred:
1-3 years of related experience in insurance billing, customer service related field or educational equivalent. General knowledge of payer specific or medical specialty billing. Good organizational and analytical skills. Knowledge of ICD-9 and CPT coding
Additional Requirements

  • The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
  • Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.

    About GuidehouseGuidehouse -is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. -Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. -If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact -Guidehouse -Recruiting at 1-571-633-1711 or via email at -. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. -Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee. -Rewards and BenefitsGuidehouse -offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. -Benefits include:
    Medical, Rx, Dental & Vision InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave and Adoption Assistance401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account, Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityTuition Reimbursement, Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare Program#Indeedsponsored

Keywords: Guidehouse, Birmingham , Third Party Representative, Other , Bessemer, Alabama

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