As a Bilingual Claims Support Coordinator, you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality patient experience within our service level agreements. The Claims Support Coordinator role serves as a liaison between plan members, providers and health insurance companies to get claims issues resolved. The Claims Support handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.
- Your primary objective is to provide effective and timely customer service for members, providers, insurer and clients regarding health care claims
- Ensure timely follow-up on requests for accounts to be reviewed
- Organize health insurance paperwork and medical record documentation
- Demonstrate knowledge of proprietary software and other required technology (Google apps, etc)
- Negotiate with providers on plan member balances
- Challenge denials of claims by the insurance company
- Communicate with medical offices, hospitals, laboratories, etc... in an effort to obtain relevant records for the patient’s case
- Contact providers and insurance companies to resolve claim concerns
- Assist with understanding of explanation of benefits (EOBs)
- Enabling members to get the errors fixed and recoup or lower their expenses by resolving their: medical bills, denied medical claims, medical letters of appeal
- Analyze and identify trends and patterns related to member billing complaints
- Collaborate with peers and management across functions
- Understand the evolving business requirements and adapt the operational processes to meet those requirements
- Speak clearly, confidently and have a friendly phone demeanor while demonstrating persuasion in overcoming objections
- Be able to handle a fast-paced dynamic environment with competing priorities
- Model a culture reflective of our Core Company Values; gain and maintain a thorough understanding of the Patient Care Team policies, processes, software, etc.
- Minimum 3 years Claims experience strongly preferred
- Hospital Claims experience strongly preferred
- Highly effective communication, problem resolution and organizational skills
- Demonstrated ability to meet goals in a rapidly changing environment
- Excellent data and overall analytical skills
- Proven track record of driving measurable efficiency results
- Knowledge of medical terminology, ICD-9/ICD-10, CPT and DRG coding a plus.
- College degree preferred (additional experience in lieu of college degree will be considered)
- Bilingual speaking, reading, and writing proficiency in Spanish/English
About Grand Rounds Health, Doctor On Demand and Included Health:
Grand Rounds Health, Doctor On Demand and Included Health merged in 2021 to form the first of its kind integrated virtual care company to raise the standard of healthcare. Our personalized, longitudinal care services include primary care, specialty care, integrated behavioral health, everyday and urgent care, chronic condition management and prevention and 24/7 triage. We get members to the right care, at the right time through ongoing clinical navigation, expert medical opinions and care coordination.
Partnering with leading employers and health plans, we deliver unparalleled, end-to-end care. Our combined nationwide practice of dedicated clinicians and innovative data science and technology platforms provide better care experiences, better member satisfaction, and better outcomes and cost savings for our nearly 100 million covered lives across commercial, Medicare and Medicaid.
Headquartered in San Francisco, the combined company has been recognized as a 2020 UCSF Digital Health Award winner for Employer Wellness and 2021 Best Workplaces in Healthcare and Biopharma™ by Great Place to Work and Fortune. Learn more at www.grandrounds.com and www.doctorondemand.com.
Grand Rounds Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Grand Rounds Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.