The Hire Solution

  • Austin, TX, United States
The Hire Solution Austin, TX, USA
Job Description Job Description The support role is expected to assist with medical cases, as well as coordinate document storage, data integrity and data transfer processes. The Healthcare Billing Specialist role is required to know the membership types, current guidelines and any department policies to ensure consistent business practices. The Healthcare Billing Specialist role is expected to comply with all HIPAA and compliance guidelines. Essential Duties: Review and determine eligibility for member cases ( appeals, reimbursements, maternity, advanced opinion). Ensure medical needs are mapped correctly to the provider and member. Map manually if needed. Ensure that all medical needs are being tracked on the files when importing or exporting data to carriers or vendors. Ensure all records are reviewed, tasks are completed, and open issues are resolved for medical review. Proactively communicate potential issues to management to allow for timely resolution. Locate...