Position Summary:
Medical Claims Processing Representatives are responsible for processing medical claims and interpreting EOBs. This is a remote position. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.
The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. IQVIA reserves the right to revise the job or to require that other or different tasks be performed as assigned.
Role Purpose:
" Processing medical claims and interpreting EOBs
Principal Accountabilities:
" Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected.
" Exceptional organizational skills are required
" To a lesser degree, the resource may provide initial support for customer requests via telephone, email, fax, or other available means of contact to the Support Center.
" Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary.
" Works under moderate supervision and typically reports to the Customer Service Supervisor.
Minimum Education & Experience:
" HIPPA certified
" Experience in claim processing required
" Medical Billing and Coding Certification required
" Proof of Active Medical Billing Certification required
" Ability to interpret Explanation of Benefits (EOB)
" Customer Service Experience preferred.
" Pharmacy Technician experience preferred.
When applying please attach a copy of your updated resume along with your Active AAPC or NHA Billing Certification showing the effective date and expiration date.
The pay range for this role is $24.00 per hour.
IQVIA is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.
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IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. We believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. Learn more at https://jobs.iqvia.com
We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe
IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding COVID-19 vaccination status. https://jobs.iqvia.com/covid-19-vaccine-status
The potential base pay range for this role is $23.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.
