Insurance Placement Solutions’ Post

"Expert Claims Handler with Proficiency in Medical Underwriting | Healthcare & Insurance Specialist." With nearly 5 years of dedicated service, my journey as a Claims Handler with S3 GLOBAL SOLUTIONS LLP has been nothing short of inspiring. From meticulously analyzing claims to steering complex underwriting decisions - my career has been a testament to my passion for blending analytical prowess with high-quality customer service. What fuels my drive? ✨ A solid grounding in evaluating files, ensuring that every detail is scrutinized for accuracy and compliance. The opportunity to collaborate closely with professionals, enabling informed decision-making that ultimately protects both companies and policyholders. A continuous quest for knowledge, staying abreast of the latest industry practices and innovations to deliver beyond expectations. As I look to the horizon, I'm eager to channel my experiences into a new challenge, specifically as a Claims Handler on a personal injury team. My aim? To not just meet the benchmarks, but to set them, contributing to a culture of excellence and innovation. 📢 I'm on the lookout for opportunities where I can leverage my expertise and make a meaningful impact. Do you know a team I can contribute to? Let's connect! Your insights or a simple share can pave the way for exciting new collaborations. #JobSearch #InsuranceIndustry #ClaimsHandling #ProfessionalGrowth #LetConnect

The credentialing process can take several months to complete, depending on the state you live in and the insurance company that you are requesting credentialing with. Here are the major factors that currently affect the process.

I am hiring for many Insurance Follow-Up Specialists- These are very long-term, W-2, 100% remote positions. FULL TIME M-F 8-4:30 est. **Epic experience is required - 3 years and must be recent** **Must have ACTUE HOSPITAL AND PROFESSIONAL BILLING EXPERIENCE*** 1. How many years of hands-on appeals experience do you have, including all the investigation required to determine if an appeal is necessary? 2. Explain your active experience in the past three years with – AR, follow up, appeals, underpayments, payor knowledge, research accounts, medical terminology. a. Does your resume reflect these skillset requirements within the last 2 years? (If not please update your resume to reflect this experience) 3. Can you provide an example of your experience with appealing denials? And resubmitting corrected claims? Underpayments? 4. Can you provide an example of a denied claim that you appealed? What steps did you take? (Please provide as much detail as possible) 5. Tell me about your experience in calling insurance companies daily checking status of past due claims? (They should know how to call BC/BS and Cigna as well as other payors to resolve claims.) 6. Tell me about your experience with using websites to check the status of multiple claims with the payors? 7. Tell me about your experience with reading an explanation of benefits? 8. Can you explain what the explanation of benefits provides? 9. Tell me about your experience with understanding medical terminology? Give examples. 10. Validate that you do not have any PTO scheduled during the first 90 days of the project. 11. Tell me about your experience in dealing with Medicare Managed Care and Medicaid Managed Care. 12. What MCO payers are you familiar with? 13. How successful have you been in collecting aged AR? 14. What is your experience with hospital /institutional claims 15. What is your backend (AR/Denials) experience working in Epic and how many years? What job functions do you do inside Epic? How were you assigned daily/weekly work to work these accounts in Epic? All resumes to [email protected] Please share- Thank you- MUST RESIDE IN USA-

Remote or hybrid work, FT with benefits, 40K+ Experience with multiple insurances, experience with CBH, Credible, Excel Must be detail oriented, motivated, reliable, a team player. 5+ years Billing/TPL/Auth experience -Call commercial insurance payersand verify each client's insurancebenefits -Confirm commercial insurance eligibility and specific coverage details for clients, communicate benefit information to the parents/guardians, and discusses financial responsibilities -Identify and document each commercial payer's policy and procedures regarding coverage, prior authorizations, andsubmission process -Complete prior authorizationrequest forms as appropriate forauthorization requests in partnership with clinical partners -Confirm that the clinicaldocumentation received is whatis required by the plan. -Ensure prior authorizations aresubmitted on time accordinglyto company and payor guidelines -Follow up with commercial insurance payers to check status of previously submitted prior authorization -Enter all documents and clientinformation or responses regardingprior authorization into companysystems -Quick to respond and communicate any changes in client's prior authorization status to care operations, clinical, andpartnerships teams. -Review and confirm all currentday copayment were collecteddaily -Process Authorization/TPL form -Check for retro coverage on existing services, resubmit as needed -Edit billing signed services and resubmit to Payers -Credentialing of company and MD, CRNP and Psychologists with insurances. #hiring

When it comes to insurance claims and legal proceedings, access to accurate medical records is vital to expedited process improvement and prompt claims handling. However, traditional methods of retrieving these records have often been cumbersome, time-consuming, and prone to errors. This has led to significant backlogs, delayed settlements, and frustration for claims adjusters and legal professionals alike. Learn how Wisedocs can assist you in streamlining your claims management with automated medical record retrieval in this insightful article. #wisedocs #automatedmedicalrecordretrieval #claimsmanagement #insuranceindustry #insuranceclaims #legalindustry #freelancewriter #articlewriter #opentowork

I am curious about medical claims denial; specifically pre-authorization, not the management of post billing/revenue recover, but simply when a doctor recommends a test or treatment, but the insurance plan will not allow coverage because their team of analysts has reviewed the documentation and overruled the doctor. What is the job title of this? What education and experience (other than the ability to say "no" to everything) is required? Is the person who makes this decision someone with a medical degree who could practice in a clinic? I have heard that health plans simply hire hundreds of people with medical credentials to deny everything they can and then have more experienced people to fight the appeals, but I know that is kind of a "trolling statement" for people who actually do this work and believe they are helping to keep health care costs down by preventing unnecessary billing...so enlighten me :)

🎉Celebrating Trelvis Randolph's 5-year Journey as a Partner at QPWB.   Trelvis' practice specializes in general liability litigation, encompassing diverse cases such as personal injury resulting from automobile accidents, slips and falls, negligent security, wrongful death, product liability, medical malpractice, malpractice in nursing homes and assisted living facilities, as well as addressing insurance coverage issues.   "To me, a part of ‘Different’ at QPWB means being able to reach your full potential with the support and encouragement of the place where you work. It is knowing that you work in a place that values and supports your ability to reach success, by whatever definition you give it. Success isn’t just confined to the work that you do at your job. It also applies to life outside of work as well, to the community. There is more to being a part of the community than just receiving what it gives you. To be a part of the community, we have to be able to work for the betterment of that society. I have made a commitment to make an impact for the betterment of the places where I work, live, and play.  Being able to make that commitment to give back to the community means a lot. I am happy to say that I work at a place that has been generous in allowing me to continue to give back to the communities in which we do business. When you work in a place that ‘gets it’, time seems to go by fast. The last five years have been the greatest and I look forward to many more."    Learn about Trelvis' practice here: https://lnkd.in/e7fk-Wgz   Ready to Discover the Difference at QPWB? We're hiring nationwide, apply today: https://lnkd.in/eJpE3Ei7   #QPWBattorney #QPWBdifferent #Attorney #Lawyer #AttorneyJobs #LawyerJobs #Hiring #HiringAndPromotion #JobOpening #JobAlert #AssistedLivingFacilities #CivilLitigation #AutomotiveLiability #GeneralLitigation #HospitalsAcuteCareFacilities #InsuranceAndInsurers #MedicalMalpracticeDefense #NursingHomes #PremisesLiability #ProfessionalMalpracticeDefense

We’re Growing & You Can Grow With Us! Hey there, LinkedIn community! Our team at PPO Negotiation Solutions is on the hunt for an organized, detail-oriented superstar to join us as a Credentialing Coordinator. What makes us excited to come to work every day? It's simple: our culture. We thrive in an environment built on respect, collaboration, trust, and open communication. Our remote work setup allows for flexibility, but it’s the support and camaraderie amongst the team that truly makes every challenge a pleasure to tackle. Now, let’s talk about the role. This 100% remote position is designed for someone who's has the keen eye of an eagle and the organizational skills of a seasoned librarian.  You'll be handling Standardized Credentialing Applications, processing terminations, supporting a team of Project Managers and navigating OPT-OUT forms with the precision of a master craftsman. You're the type who makes a verification call feel like a friendly chat, yet you're eagle-eyed enough to spot an expired document from a mile away. Your exceptional time management skills mean deadlines don’t scare you – they motivate you. If you’re nodding along, you might just be our ideal candidate. We’re looking for: Phone Enthusiast: Enjoys being on the phone with insurance companies, as 50% of the job involves phone-related tasks, completing verification calls, and coordinating energies between the Client and project manager. Problem Solver: Can manage contracts like a pro, ensuring smooth and efficient operations. Top-Notch Communicator: Articulates complex ideas with ease and clarity. Interpersonal Champ: Knows how to foster relationships and earn trust from colleagues and clients alike. Detail-Oriented: A master of detail – nothing gets past you. Independent Spirit: Can juggle multiple projects without breaking a sweat. Great Attitude: Brings positivity and enthusiasm to the team. Team-Oriented: Works well with others and contributes to a collaborative environment Does this sound like you? Do you love the idea of working with a team that values your input and treats you like the rockstar you are? If yes, we can’t wait to meet you! Let’s create some magic together and transform the PPO landscape, one credential at a time.   If you have these skills, we have a training program to get you on track very quickly with this position. Interested? Apply now and let’s chat about how you can be a part of our PPO Negotiation family! Click here to apply :  https://lnkd.in/eM3hv_ax #Hiring #RemoteJob #CredentialingCoordinator #TeamCulture #PPOFamily #WorkFromAnywhere

🏗️ Avoid the biggest mistake when hiring a contractor🚫 ❌DON’T Hire someone without a valid license and insurance. 🧐Always make sure you check with the State to confirm their credentials, it's as easy as making one simple phone call. ☎️ Why would you take the risk?🤔 #ContractorHiring #LicenseAndInsurance

If you were part of a recent #layoff, were #laidoff and are a #jobseeker #opentowork never fear! There are lots of #hotjobs available!! Check out this new #jobposting with Scott Galanos! I can help you navigate your search with my 19 years of experience in the industry and as a #resumewriter. I can prepare a strong ATS friendly resume to get you results and get you back to work QUICKLY! There is a lot more competition with the recent #layoffs, so it’s even more important you stand out from the competition, and you have a proven job search strategy. How I can help you: • Customized resume preparation- taking the time to thoroughly understand your expertise, not just providing a basic questionnaire or mass-produced “cookie-cutter” resume template. • LinkedIn profile preparation/optimization. • Job search coaching to walk you step-by-step through the process so you aren’t aimlessly applying to jobs and not getting responses. • Freelance Recruiter with a vast network of hiring manager/recruiter contacts to connect you to. 58 of my clients accepted offers for new jobs in 2023 already, 124 in 2021 and 112 in 2022! One obtained a $70K increase in her previous salary, one DOUBLED his salary, one a $50K increase, one a $55K increase and another a $35K increase!   Please take advantage of my FREE RESUME REVIEW offer on my website. https://lnkd.in/g-4bcFV   “Remember you only get one chance to make a first impression, make it a Professional Impression!!”   #careercoach #ono