Would you like to be part of a growing national healthcare solutions company?
Are you looking to positively affect thousands of lives each day via health benefits?Do you have experience in medical claims analysis?
We are hiring for a Allied Advocate Specialist to join our team.
Who we are Allied is a national healthcare solutions company that supports healthy workplace cultures.
What we do We are problem-solvers, innovators, and collaborators.
Our purpose is to work with employers to take care of their employees and their families every day and it all starts with the Allied family.
Whats in it for you?
Allied supports an inclusive culture focused on developing employees to succeed, innovate & impact the community.
Heres how we do it Training and Development: Allied offers tailored learning and development curriculums for all employees and a Learning Management Database with thousands of courses for professional and personal development.
Career Mobility: Growth opportunities are endless at Allied.
In 2021 alone, one in five employees had a job change.
75% of these job changes were promotions Employee Engagement:We pride ourselves on employee engagement With our recognition program, employees recognize their colleagues monthly or donate to charities with cash rewards.
Allied has a dedicated committee planning monthly engagement activities to create endless opportunities to get to know your peers and destress in this new remote world.
Employee Feedback: We regularly survey our employees throughout the year to seek continuous feedback, ideas and suggestions on new initiatives.
Community Outreach: We have dedicated committees focused on fundraising efforts supporting our employees and their families, furthering education goals and providing funds for charitable organizations outside of Allied.Would you like to be part of a growing national healthcare solutions company?
Are you looking to positively affect thousands of lives each day via health benefits?INSERT QUESTION RELATIVE TO THE SPECIFIC JOB AS WELL AS ANY DETAILS TO HIGHLIGHT WHY THIS ROLE IS THE BEST We are hiring for a _ to join our team.
Who we are Allied is a national healthcare solutions company that supports healthy workplace cultures.
What we do We are problem-solvers, innovators, and collaborators.
Our purpose is to work with employers to take care of their employees and their families every day and it all starts with the Allied family.
Whats in it for you?
Allied supports an inclusive culture focused on developing employees to succeed, innovate & impact the community.
Heres how we do it Training and Development: Allied offers tailored learning and development curriculums for all employees and a Learning Management Database with thousands of courses for professional and personal development.
Career Mobility: Growth opportunities are endless at Allied.
In 2021 alone, one in five employees had a job change.
75% of these job changes were promotions Employee Engagement:We pride ourselves on employee engagement With our recognition program, employees recognize their colleagues monthly or donate to charities with cash rewards.
Allied has a dedicated committee planning monthly engagement activities to create endless opportunities to get to know your peers and destress in this new remote world.
Employee Feedback: We regularly survey our employees throughout the year to seek continuous feedback, ideas and suggestions on new initiatives.
Community Outreach: We have dedicated committees focused on fundraising efforts supporting our employees and their families, furthering education goals and providing funds for charitable organizations outside of Allied.
What will you be doing?
Determining the proper payment (if any) of medical claims by group health plans, based upon specific knowledge and application of each clients customized plan(s).
ESSENTIAL FUNCTIONS Independently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud.
Determine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider.
Contact providers to negotiate discounts.
Log claims negotiated in Access database, and create weekly summary reports.
Review and understand the terms and conditions of each clients customized plans.
Understand and comply with all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
Request, review and analyze any physician notes, hospital records or police reports.
Consult with other entities who can offer additional evaluation of a claim.
Process claims in the QicLink System.
Review, analyze and add applicable notes to the QicLink System.
Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.
Review billed procedure and diagnosis codes on claims for billing irregularities.
Analyze claims for billing inconsistencies.
Review and analyze specific procedure and diagnosis codes for medical necessity.
Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
Review Suspended Claim Reports and follow up on open issues.
Assist and support other team members as needed and when requested.
Attend continuing education classes as required, including but not limited to HIPAA training.
Other duties as assigned SKILLS & ABILITIES All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology.
Continuing education in all areas affecting group health and welfare plans is required.
Experience Applicants must have a minimum of 2-3 years of medical claims analysis experience Education High School Diploma College and Advanced Degrees Preferred PHYSICAL DEMANDS Ability to work with computer based programs for extended periods of time.
WORK ENVIRONMENT Remote Work Schedule: Flexible full-time hours within core business hours