TO APPLY: EMAIL YOUR RESUME TO JOBS@MAESTROHEALTH.COM
We are an employee health & benefits company with a tech-meets-service platform that simplifies and personalizes how employees and employers shop, enroll and live with their benefits. Our innovative technology makes it easy for employees to choose the right benefits plan while equipping HR with the tools they need through one partner, one service team, one platform, one portal.
Maestronites are brought together with a passion to disrupt the status quo by reimagining employee health and benefits. This passion has driven us to create the first complete platform that optimizes the entire benefits experience for everyone. Our people, passion and platform are united by our mission: to make employee health & benefits people-friendly again.
WHAT YOU WILL BE DOING:
Our Health Plan Management business serves customers with 250-10,000 employees who self-fund their own group health plans. A cornerstone of our strategy is correct provider reimbursement and medical claim audits. The Provider Reimbursement Specialist will be responsible for the development and implementation of provider reimbursement strategies for self-funded plans. Daily responsibilities include but are not limited to:
Manage inbound inquiries to resolution from medical providers and/or plan members seeking to understand our reimbursement and payment methodology
Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language
Use Microsoft Office products to generate letters, explanations and reports to explain medical reimbursement approaches and communicate this information to providers, vendor partners, and plan members
Provide input for new process development and continuous improvement
Formulate solutions to quickly address issues, concerns and problems
WHAT SUCCESS LOOKS LIKE:
Cross-functional collaboration with your fellow Maestronites and innovative thinking will be essential to your success and growth.
Plan Members, Providers, and other employees respond favorably when surveyed about interactions with you
You are recognized as taking complete ownership of claim audits and close your cases within a reasonable time from receipt (based on complexity)
Maintain high level of attention to detail regarding reimbursement reviews.
You are recognized as demonstrating our core values: Fun. Preparedness. Kindness. Teamwork. Humility. Urgency. Bold Thought. Honesty.
WHAT YOU NEED:
Associates's degree or equivalent combination of related experience
Experience with a medical billing office and/or a legal office environment
Ability to effectively diagnose potential barriers and propose resolutions that have measurable and positive business impact
Comfortable working in a fluid environment where there may be no clear solution
Have or be willing to obtain a medical coding certification from the American Academy of Professional Coders (AAPC)
Encourage and support accountability and engagement, including sharing of information, ownership and successes with others
Ability to build relationships and augment our reputation through providing a very high quality of service and responding to requests in a timely manner
WHY WORK AT MAESTRO HEALTH?
We have great benefits:
Personal, Vacation and Sick Time
Medical and Prescription
Life and Disability
Health and Wellness programs
401k with Employee Match
Figo - Pet Insurance
We have great perks in each of our offices, along with a fun, energetic and fast-paced environment, and what will really drive you is our vision. Maestro Health is making employee health & benefits people-friendly again by making healthcare easy to understand, tools easy to use and costs easy to control. We are aiming to become a household name within the employee health & benefits space.
We can’t do that without great people. We want to hear “WOW! That was the best job and business experience I ever had!” from every Maestronite – past, present and future. You should be personally challenged and look forward to coming to work.
Are you ready to become a Maestronite? Let’s do this.
Maestro Health is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability or veteran status.