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Healthcare Claims Advocate

Company: Rightway
Location: Miami
Posted on: May 15, 2022

Job Description:

ABOUT RIGHTWAY
At Rightway we are committed to creating a diverse environment and are proud to be an equal opportunity employer. We hire for the best talent and actively seek diversity of thought processes, beliefs, background and education. Rightway fosters an inclusive culture where differences are celebrated to drive the best business decisions possible.

We are committed to equal opportunity and fairness regardless of race, color, religion, sex, gender identity, sexual orientation, nation of origin, ancestry, age, physical or mental disability, country of citizenship, medical condition, marital or domestic partner status, family status, family care status, military or veteran status or any other basis protected by local, state or federal laws.
Rightway Healthcare was founded in early 2017 by a team of dedicated healthcare, business and technology leaders. Rightway is a technology platform that provides employees and their families with the support, information and advocacy they need to be better healthcare consumers.

We combine a high-tech consumer portal with a high-touch dedicated concierge environment to provide consumers with the same level of support and guidance they would receive if they had a doctor in the family. We are focused on personalization, implementation, advocacy and results.
Rightway works with employers from 100 - 25,000 employees to provide an ecosystem of healthcare navigation for employees. We are committed to generating high member satisfaction scores, industry leading engagement and a quantifiable ROI for every employer. Our approach is rooted in analytics and guided by a bottom-up understanding of a population.
Rightway is privately financed, having raised over $130mm to date from investors such as Thrive Capital

The company is headquartered in New York City, with new offices in Hudson Yards. We also have remote offices in Miami, Denver and San Francisco.
RESPONSIBILITIES
Determines coverage for medical, dental, and vision procedures by studying provisions of the member's health policy
Extracts additional information as required from outside sources, including claimant, physician, employer, hospital, insurance carriers and other third partners
Initiates investigation of questionable claims
Resolves medical, dental, and vision claim and billing questions and issues byexamining the summary of benefits
contacting the carrier and/or the provider billing office to ensure member is not being overcharged
calculating out-of-pocket costs based on benefits
initiating reimbursement requests with the carrier
composing appeal letter
Provides information on year-to-date deductible, copay, and coinsurance activity to team members
Maintains quality customer service by following customer service practices and responding to customer inquiries in a timely manner
Protects claimant information by following HIPAA guidelines
Reports claim status updates in proprietary CRM and provides detailed information of each claim

REQUIREMENTS
Our Navigation Operations is a fast-paced, dynamic, and a growing environment. We are looking for individuals who are passionate about concierge service delivery and changing the healthcare experience for consumers. This role will be office based, not a remote position.
Strong communication skills, both written and verbal
Professional experience with both benefit plan interpretation, provider billing practices and claim adjudication
Strong demonstration of critical thinking and problem solving skills
Bachelor's degree in health sciences or related field and minimum of 3 years of experience as medical claims specialist.

Rightway is a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.
Rightway is PROUDLY an Equal Opportunity Employer that believes in 'strength in the diversity of thought processes, beliefs, background and education' and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.

Keywords: Rightway, Miami , Healthcare Claims Advocate, Healthcare , Miami, Florida

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