Medical Claims Specialist/Examiner at Vanguard Temporaries, Inc.

Long Term Temporary, Possible Temporary to Direct Hire Medical Billing/Claims Coordinator - Monday through Friday, 9am to 5pm, Fully On-Site. Communicate via telephone and written correspondence with providers, members, attorneys, or collection agencies to resolve balance billing/fee negotiation inquiries. Handle large call volume in reference to balance billing inquiries. Negotiate and resolve large volume of balance billing inquires, negotiate fees and discounts for members with nonparticipating providers to reduce out of pocket expenses. Analyze received correspondence; verify member eligibility, claim history and coordination of benefits. Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover monies. Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices. Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner. Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network. Educate members and providers with out of network fees, out of pocket expenses and benefits of using the Funds network. Perform additional duties and projects as assigned by management.