Health Event Adjudicator & Administrator

Date Posted: 

November 1, 2022

Purpose

To support CrowdHealth’s mission of caring for Members by providing organized, timely, and excellent adjudication and administration of health events.

Scope

The Health Event Adjudicator and Administrator supports the Operations Team by working alongside Care Advocates and the Crowdfunding Controller to:

  • Perform initial processing for medical bills, including data entry and basic adjudication;
  • Research and identify high-quality, fairly priced medical practitioners and facilities;
  • Maintain organized information through various technological systems;
  • Assist with escalated health events, and
  • Embrace additional opportunities to supportCrowdHealth’s Operations as they arise.

Reports to the Director of Operations.

Outcome

Efficient, organized Operations leading to a thriving Crowd of Members experiencing high-quality, fairly priced health care. Measured by accuracy, timeliness, and overall success of Operations team goals.

Responsibilities

Health Event Adjudication

  • Provide initial review of bills and payment documentation submitted by Members, including dates of service, CPT codes, and other care details, to validate funding eligibility.
  • Perform data entry of basic bill information, such as nature of charges, date of service, provider details, and amounts paid.
  • Update bill statuses to indicate fields or documents that are missing or under review.
  • Escalate issues, concerns, and questions to Crowdfunding Controller in a timely manner.

Health Event Administration

Support Care Advocates with Members’ Find-a-Doc requests, including:
  • Researching providers within given geographic area (e.g. Member ZIP code);
  • Contacting medical offices to determine cash-pay friendliness, acceptance of new patients, estimates of charges for services needed, etc.;
  • Equipping Care Advocates with recommended provider documentation within appropriate timeline of Member request;
  • Adding provider information to Find-a-Doc database; and
  • Supporting Care Advocates in following up with Members on experience with recommended providers.
Maintain and organize specific information through a variety of systems, including:
  • Coral (health care bundles and discounted labs/imaging/tests);
  • Monday.com (status updates for various tasks and projects); and
  • Internal database of Member and health event data.
Provide administrative support to escalated health events, including:
  • Requesting medical records on behalf of clinical review and negotiation partners;
  • Creating case summaries for escalated events; and
  • Providing notes and follow-up to Care Advocates.

Take on additional tasks and projects to support the success of the Operations Team as needed.

Qualifications

Three or more years of experience in health care adjudication or administration. Must possess a can-do attitude and agility to thrive in the startup environment, along with a passion for helping people overcome a complicated and burdensome U.S. healthcare system.

Skills

  • Excellent listening ability, to give full attention when discerning the needs of the Operations team.
  • Discernment and the ability to identify bills that seem out-of-place and should be escalated.
  • Pleasant personality, able to communicate effectively with health care providers on behalf of Members and maintain a positive reputation within the health care sector, to support growth of the CrowdHealth platform and Member Community.
  • Proficiency at technology and an ability to learn and utilize a variety of systems, such as Monday.com, Slack, Dropbox, Microsoft Office, Zendesk, and internal systems.
  • Organization, with a keen attention to detail, high quality of work, and a precise understanding of what a CrowdHealth Membership includes.
  • Positivity, a willingness to learn and support a growing team and company with a can-do attitude.

Email resume and cover letter to Director of Operations, Margaret Gibson, at margaret@joincrowdhealth.com.