Description
The FWA Specialist is responsible for negotiating out of network claims with providers; reviewing/auditing claims for fraud waste and abuse; working with outside vendors; and processing various types of claims.
Key Responsibilities
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Follow procedures to negotiate a percentage of savings on claims forwarded from the claims department.- Process claims when returned and process percent of saving invoices.
- Track all backlog and production numbers for reporting purposes.
- Assist in creation and improvement of policies and procedures for the Fraud, Waste & Abuse Department.
- Assist FWA Team in requesting records, routing claims for review, and sending letters.
- Assist in processing various claims when needed.
- Assist in special projects assigned by Team Lead or Manager
Skills, Knowledge & Expertise
- Knowledge of medical terminology including ICD-9, CPT, & HCPCS coding is required. Coding certification is a plus.
- Ability to read, understand, and apply contract benefits, limitations, and provisions. Understand and carry out complex written and oral instructions.
- Ability to negotiate and communicate with providers effectively and confidently.
- Creative and innovative thinker with excellent analytical skills.
- High attention to detail and accuracy.
- Excellent verbal and written communication skills.
- Ability to multi-task, organize, and prioritize tasks/assignments.
- Working knowledge of MS Word and Excel.
Benefits
- Competitive pay with opportunity for career advancement
- Paid time off policy to support a healthy work-life environment
- Full offering of health and wellness benefits for you and your family
- Company paid life insurance and disability plan
- 401K plan with company matching
- Employee discounts and wellness program
About HealthComp
Operating since 1994, we’re a third-party administrator (TPA) committed to providing employers with all the services needed to administer their benefits efficiently resulting in better health outcomes for their employees and higher cost savings for them. We partner with a variety of health providers and technology vendors to ensure a robust offering of medical, dental, vision, COBRA, HIPAA, flexible spending accounts and reference-based pricing, so members can make the most out of their benefits. It’s comprehensive care without the confusion.
HealthComp is an Equal Opportunity Employer.
HealthComp recruiting correspondence will always come from a talent acquisition representative with an official @healthcomp e-mail address. In addition, our representatives will never ask for any form of payment from a new hire or candidate. Please report suspicious activity to hiringsecurity@Healthcomp.com.
HealthComp is an Equal Opportunity Employer.
HealthComp recruiting correspondence will always come from a talent acquisition representative with an official @healthcomp e-mail address. In addition, our representatives will never ask for any form of payment from a new hire or candidate. Please report suspicious activity to hiringsecurity@Healthcomp.com.
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