Determination Adjudicator

Location

Utah | United States

Job description

Who We Are

Zion HealthShare is a nonprofit medical cost-sharing program that provides an organized structure for members to contribute toward each other's medical costs. We offer individuals and organizations across the country an affordable alternative to insurance; this provides peace of mind. Our goal is to be America's leading HealthShare. We strive to meet our members' needs on a personal level by following our core values: inclusive, transparent, simple. Everything we do for our members is to ensure they feel respected and to let them know we truly care about their needs.

Essential Duties and Responsibilities:

· Evaluate all Medical Need Submissions received from members to determine eligibility for sharing into medical expenses.

· Communicate effectively and consult with members, providers, and team members as necessary throughout the determination process.

· Keep members and providers informed and updated about medical needs through regular verbal and written communication.

· Act with a sense of urgency in making determinations on medical needs.

· Maintain HIPAA compliance and company compliance policies.

· Takes inbound and outbound phone calls from members and providers regarding questions or concerns with the eligibility determination.

· Providers support to email inbox management

· Assists with requests and following up on obtaining medical records.

· Continuously strive to exceed member expectations ensuring a high level of member satisfaction.

· Provide recommendations to the Zion HealthShare Member Guidelines as needed.

Required Skills and Abilities:

· Minimum - Active Utah Medical Assistant (MA) license

· Professional level of written and verbal communication that demonstrates directness, compassion, and empathy.

· Microsoft Office Suite Proficiency

· Ability to read and interpret medical records.

· Ability to work effectively within a team.

· Sincere desire to help other people.

· Time Management

· Attention to detail.

Education:

· High school diploma

· Minimum Requirement - Utah Medical Assistant (MA) license

Physical Requirements:

· Sit for up to 8 hours a day and look at dual computer screens.

· Type on a keyboard at a minimum of 45 WPM.

Experience preferred:

· 3+ years relevant medical records and medical terminology experience

· Working knowledge of healthcare industry, policies, and guidelines

· Experience working with and interpreting medical bills, statements, receipts, and medical records.

· Familiarity with HIPAA.

· Experience or familiarity in working from a CRM (Customer Relationship Management) system.

· Spanish Speaking

Benefits:

· Medical, dental, and vision insurance

· 401(k) plan with company match

· Paid time off (PTO)

· Short-term disability insurance

· Life Insurance

· Paid holidays

Compensation:

$22.00 per hour | $23.00 per hour after 60-day training

Job Title: Determination Adjudicator

Work Location: 1141 W Silicon Way, Suite A. St. George, UT 84770

Work Status: Full-time, exempt

Hours of Operation: 7:00 AM - 5:00 PM

Job tags

Salary

$22 - $23 per hour