<p>Blue Cross of Idaho is seeking a Provider Resolution Specialist. This role acts as a primary investigator for researching, analyzing and responding to provider inquiries and appeals within contractual requirements and plan guidelines.</p> <p>This role is located at our corporate headquarters in Meridian, ID and offers a hybrid work schedule.</p> <p>We are looking for a Provider Resolution Rep with:</p> <ul> <li>3+/4+ years' health industry or related experience. </li></ul> <p>What a day as a Provider Resolution Specialist I may look like:</p> <ul> <li>Interpret provider contracts ensure the alignment with processes and procedures. </li><li>Engage with and educate providers regarding their fee schedules, claims processing and contractual requirements while maintaining a collaborative relationship. </li><li>Review medical records and other documentation to ensure all required information is included to make a case determination. </li><li>Review the correct application of ICD-10, CPT, HCPCS and other medical coding guidelines. </li><li>Review, process and adjust claims for all lines of business. </li><li>Perform other duties and responsibilities as assigned. </li></ul> <p>Additional skills we are looking for:</p> <ul> <li>Business writing </li><li>Medical Terminology </li><li>Coding certifications or familiarity with current medical coding guidelines </li><li>Claims processing or related experience </li><li>Experience with contract language </li></ul> <p>As of the date of this posting, a good faith estimate of the current pay range is $23.11 to $35.77. The position is eligible for an annual incentive bonus (variable depending on company and employee performance.</p> <p>The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.</p> <p>We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.</p> <p>We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.</p> <p>Reasonable Accommodations</p> <p>To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <p>We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.</p>