medical science liaison Isabela, PR
Job description
Job Summary
Medical Reviewer for Appeals is responsible for arbitrating cases, understanding medical claims and coding determinations, communicating with appropriate parties, such as medical providers and health insurance companies and performing other tasks as required to arbitrate a dispute. This position will report on-site at our location in 699 Industrial Avenue, Isabela PR 00662.
Puerto Rico Benefits Include:
- Pay Rate: $16.34 p/h ($33,987) (Non Exempt/Full Time)
- Health Insurance- medical, dental, vision & pharmacy benefits. (Employer contribution included). Active 1st day after 30 days of employment.
- Company sponsored Life Insurance. Active 1st day after 30 days of employment.
- 401K Retirement plan. Active 1st day after 6 months of employment.
- Vacation Leave and Sick Leave dictated by current PR Labor Law.
- Employee Assistance Program
- Paid Training
- 11 Paid Holidays
- Wellness Program
Job duties include, but are not limited to:
- Review and analyze case file materials that involve claims payment disputes
- Determine if an organization conflict of interest exists
- Review and determine if the claims payment dispute is eligible for review
- Assess completeness of all case file materials
- Identify missing information and communicate with stakeholders to obtain missing information/documentation
- Apply rules to determine appropriate path and document findings
- Review and analyze medical claims and coding to confirm coding was appropriate
- Obtain appropriate and pertinent information from various sources
- Create a draft payment determination for review by an Arbitrator/Attorney Reviewer
- Adhere to all required timeliness and quality
- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office Products
- Performing other duties as assigned by management
Minimum Qualifications for the position:
- Associate's Degree from an accredited college or university or equivalent experience
- At least two (2) years of experience in a medical billing, claims processing, or related position required
- Ability to type at least 45 WPM
- Proficient in Microsoft Office, with accurate data entry skills
- Strong organizational, interpersonal, written and verbal communication skills
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment
- Ability to successfully execute many tasks simultaneously
- Willingness to transition to a variety of tasks
- Ability to work as a team member, as well as independently
About Capitol Bridge
Founded in 2012, Capitol Bridge is based in Arlington, Virginia and is a SBA 8(a) Certified Small Disadvantaged Business with proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.
Screenings Required
You will receive requests for background check and/or drug screen regarding this employment opportunity.
Reasonable Accommodation
Capitol Bridge complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, or to receive other benefits and privileges of employment, please contact your recruiter.
EEO Statement
Capitol Bridge is an Equal Opportunity Employer. All employment decisions at TDB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.
Texting Notice
We communicate with applicants by text in additional to email and phone. If you apply for this position, we may text you about this position, your application for the position or other things relevant to this job position. If we text you and you no longer want us to text you, you can opt out at that time.
Job Type: Full-time
About Capitol Bridge
Revenue: Unknown / Non-Applicable
Size: 51 to 200 Employees
Type: Company - Private
Website: https://capitolbridgellc.com/
