Company Overview:
MotivHealth Insurance Company, launched in May 2015, is a Salt Lake City, Utah-based health insurance innovator dedicated to tackling the high cost of healthcare through member empowerment, price transparency, and cutting-edge cost-containment services.
Job Description:
We are seeking a highly organized and detail-oriented professional to join our team as a Cost Containment Specialist. In this role, you will be responsible for screening healthcare review requests, preparing and managing case review packets, coordinating with providers and Nurse Reviewers, and ensuring the accuracy and completeness of all case materials. The ideal candidate will demonstrate strong multitasking abilities, excellent written and verbal communication skills, and a commitment to maintaining confidentiality and compliance with HIPAA regulations. A background in the health insurance industry is essential for success in this position.
Responsibilities and Duties
- Screen incoming medical records for completeness and ensure all required materials are available for case evaluation
- Prepare, organize, distribute, bookmark, and present medical records, materials, and forms necessary for healthcare case review packets
- Contact providers to request missing information as needed
- Identify and assign appropriate Nurse Reviewers for healthcare case reviews
- Audit completed cases for content accuracy, grammar, spelling, and proper written notifications
- Submit completed cases to Nurse Reviewers for final assessment
- Review audits and process claims in accordance with company and industry standards
- Ensure strict compliance with HIPAA regulations and all applicable legal guidelines
- Perform other related duties and special projects as assigned
Required Qualifications
- 2+ years of experience in the health insurance industry or a closely related field
- Strong understanding of medical insurance terminology
- 2+ years of medical claims processing knowledge
- Advanced written and verbal communication skills
- 2+ years' experience handling and managing medical records
- Proficient in Microsoft Office Suite, including Excel, Word, and PowerPoint
- Skilled at processing information quickly and making sound decisions under pressure
Skills and Abilities
- Team Collaboration
- Attention to Detail
- Multitasking
- Decision-Making
- Organization
- Multitasking