Job Description:

Description

Claims Resolution Representative will assist with research to resolve outstanding issues and provide guidance in a variety of duties according to Wyoming Department of Health. This position is responsible for accurate and timely resolution of all claim types, and updates to operational procedures This position is in Cheyenne, Wyoming.

Job Responsibilities:

• Independently resolve suspended claims using the resolution screens in accordance with operational procedures.


• Review and analyze claims and follow up on the status of claims and reimbursement; ensure accuracy and consistency of claims processing;


• Identify areas for provider education to promote provider claims correction on their first response and communicate these to management and Field Representatives.


• Train on operational procedures and review operational procedures and standard management practice.


• Fix errors or inconsistencies as they are identified and notify staff member(s), when applicable, and re-train as required.


• Research and review submitted bills (paper or electronic) and process according to Wyoming Department of Health policies and procedures;


• Perform manual pricing and audit checks to ensure compliance with Wyoming policies and rules; perform manual reviews on claims, documents, and attachments; review and process suspended claims and submitted documentation.


• Facilitate manual entry of claims into the system; research and electronically track suspended claims


• Implement workflow processes and capabilities for work queues with the ability to route workstreams between CNSI and the state; assist the state in simplifying business rules and policies.

Experience/Preferred Skills Required:

• High School diploma or GED with at least two (2) to five (5) years' experience conducting research to resolve issues within the healthcare field.

• Available to work from 7:00 AM to 6:00 PM, Monday through Friday.

• knowledge of claims and medical terminology including medical diagnosis and procedure codes, and claims pricing methodologies such as DRG, manual pricing, and fee for service experience.


• Knowledge of medical bill/claims forms, ICD-10CM coding, CPT coding, bill forms, and other medical coding schemes


• Able to simultaneously maneuver through various computer claims and eligibility platforms.

• Proficientin Microsoft Office Windows, including Microsoft Word, Excel, and Outlook.

• Excellent oral, written, verbal communication skills and organization, time management skills and can establish priorities effectively.

• Interact in a professional and courteous manner; communicate efficiently and effectively with supervisors, co-workers, and external customers.


• Work well under pressure, with some interruptions, and in a team/group setting; and are dependable in both production and attendance.

About Us:

At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We're passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.

Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability and fun! You will be offered a competitive compensation and benefits package.

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.