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Medical Determination Specialist
Location:
Saint George, UT
Description:
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
Company:
Zion Healthshare
Posted:
November 14 on ApplicantPRO
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