Job Description
About Conduent
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.
You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Job Description
Conduent is hiring a Remote Reimbursement Review Services Representative-Provide Add
Pay: $19/hr
Training hours: 8-5 EST M-F (2-4 weeks)
Work hours: Flexible but must work a 40 hour week
Must pass a background screen prior to employment
Must have a HS diploma or GED
Desired Experience: Claims, billing/coding experience
Duties include:
Nightly report from GCHP/Evips
EFT changes
Member LOAs (M50 pends)
Member non covered requests (M58 pends)
Provider Add 2 day TAT workgroup – events sent from OPS team
CCDs for vendor/provider updates
Perfect Claim triage
Creating/maintaining special match rules
W9
Move claims to EIN NOT FOUND queue and next day reject those claims so the claims are not counted in inventory.
Receive W9s and add corporation to the system
Add vendors/providers to support the claims
Un-reject claims and set the clean date based upon the date the corporation’s W9 was received
Push claims through Medi-Trac
Job Track Description:
Performs business support or technical work, using data organizing and coordination skills.
Performs tasks based on established procedures.
In some areas, requires vocational training, certifications, licensures, or equivalent experience.
General Profile
Ability to perform analytical and operational processes.
Entry-level position with limited requirements for licenses, training, and certifications.
Applies experience and skills to complete assigned work.
Works within established procedures and practices.
Works with a close degree of supervision.
Functional Knowledge
Has basic skills in a range of processes, procedures and systems.
Business Expertise
Understanding of how best teams integrate and work together to achieve company goals.
Impacts a team, by example, through the quality service and information provided.
Follows standardized procedures and practices.
Receives close supervision and guidance.
For consistency, methods and tasks are described in detail.
Leadership
Has no supervisory responsibilities.
Problem Solving
Ability to problem solve, self-guided.
Has limited opportunity to exercise discretion.
Interpersonal Skills
Exchanges information and ideas effectively.
Responsibility Statements
Receives, processes, and ensures document classification are completed and transmitted to clients.
May require outbound correspondence from the client to be processed.
Receives documents from both electronic and hard copy forms for processing.
Sorts, images, documents, files, and archives by form type.
Identifies documents and their purpose; creating a database of information.
Classifies documents based on contract requirements.
Captures information based on client requirements.
Verifies data from automated data extraction tools.
Ensures transmission of processed data to the appropriate next level.
Performs other duties as assigned.
Complies with all policies and standards.
Job Track Description:
Performs tasks based on established procedures.
Uses data organizing and coordination skills to perform business support or technical work.
Requires vocational training, certifications, licensures, or equivalent experience.
General Profile
Has advanced and specialized expertise within a range of analytical or operational processes.
Completes assignments and facilitates the work of others.
May coordinate assignments beyond work area.
Proposes improvements to processes and methods.
Acts as a lead, coordinating the work of others, but is not a supervisor.
Works autonomously within established procedures.
Functional Knowledge
Has developed skills in a range of processes, procedures, and systems.
Acts as a technical expert in some areas.
Business Expertise
Understanding of how teams integrate and work best together to support the achievement of company goals.
Impact
Impacts a team, by example, through the quality service and information provided
Suggests work procedure and practice enhancements to improve efficiency.
Leadership
Serves as a team lead.
May allocate work to team members.
Provides subject matter guidance to junior team members.
Problem Solving
Provides solutions to atypical problems with little or no precedent.
Interpersonal Skills
Clearly and effectively exchanges information and ideas.
Responsibility Statements
Eliminates barriers to reimbursement and access for patients with complex and rare medical conditions.
Builds relationships with patients, caregivers, HCSs, and Sales Teams to coordinate participation in the program.
Researches available disease-specific information in the assigned region.
Reports adverse events and product quality complaints, per policy.
Advocates on behalf of the patient to problem-solve issues or obtain necessary information.
Acquires and maintains subject matter expertise in rare or chronic diseases to ensure staff is providing the appropriate support and services.
Coordinates training for new and existing team members.
Conducts quality audits of calls and process flow documentation.
Performs other duties as assigned.
Complies with all policies and standards.