Provider Resolution Specialist I – R2915-6334

This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2267523 Blue Cross of Idaho is
seeking a Provider Resolution Specialist. This role acts as a primary
investigator for researching, analyzing and responding to provider
inquiries and appeals within contractual requirements and plan
guidelines.

This will be a hybrid position following training. You must reside in
the Treasure Valley area in order to be considered.

We are looking for a Provider Resolution Rep with:

– 3 years health industry or related experience.

What your day may look like:

– Interpret provider contracts ensure the alignment with processes and
procedures.
– Engage with and educate providers regarding their fee schedules,
claims processing and contractual requirements while maintaining a
collaborative relationship.
– Review medical records and other documentation to ensure all
required information is included to make a case determination.
– Review the correct application of ICD-10, CPT, HCPCS and other
medical coding guidelines.
– Review, process and adjust claims for all lines of business.
– Perform other duties and responsibilities as assigned.

Additional skills we are looking for:

– Business writing
– Medical Terminology
– Coding certifications or familiarity with current medical coding
guidelines
– Claims processing or related experience
– Experience with contract language

Reasonable Accommodations

To perform this job successfully, an individual must be able to perform
each essential duty satisfactorily. The requirements listed above are
representative of the knowledge, skill and/or ability required.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against
any employee or applicant for employment because of race, color, sex,
age, national origin, religion, sexual orientation, gender identity,
status as a veteran, and basis of disability or any other federal, state
or local protected class.