IQVIA is hiring a Care Navigator to join our team. This is a 100% remote position where you will be responsible for processing medical claims for payment assistance programs. Your primary duty will be to receive and vet medical claims against specific program rules to determine if they should be paid or rejected.
What You'll Do
- Receive medical claims from healthcare providers or patients.
- Ensure adequate supporting documentation is provided with each claim.
- Interpret Explanation of Benefits (EOB) and CMS1500 forms.
- Vet claims against program-specific business rules.
- Determine if claims should be paid or rejected.
- Provide customer support via telephone, email, fax, or other contact means.
- Recognize operational challenges and suggest recommendations to management.
What We're Looking For
- High School Diploma or equivalent.
- Experience in claim processing.
- Active Medical Billing Certification with CEUs up to date or willingness to get certification.
- Active Medical Coding Certification with CEUs up to date or willingness to get certification.
- Medical Billing experience.
- Ability to interpret Explanation of Benefits (EOB).
- HIPAA trained.
- Ability to work 40 hours per week under moderate supervision.
Nice to Have
- Infusion or Hospital Billing Experience.
- Customer Service Experience.
- Pharmacy Technician experience.
Team & Environment
This is a contract role managed by an external agency with an opportunity for conversion to a full-time employee.
Benefits & Compensation
- Compensation of $24.00 per hour base pay range.
Work Mode
This is a fully remote position.
IQVIA is an Equal Opportunity Employer. All qualified applicants receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected status.
