Representative II - Provider Claims Service Center
This is a call center role that focuses on only Provider Claims and Billing.
MUST HAVE - Provider Claims or Medical Billing experience - 2
recent years in a High Volume Call Center experience (please specify call amount of calls handled on resume or comments.
) - Looking for candidates with proven success in call center roles - Please do not submit candidates that have only worked short tenured roles in call centers Position
Summary:
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
Triages resulting rework to appropriate staff.
Documents and tracks contacts with members, providers and plan sponsors.
Duties:
( ) Explains member's rights and responsibilities in accordance with contract.
( ) Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
( ) Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
( ) Responds to requests received from Healthcare's Law Document Center regarding litigation; lawsuits.
( ) Handles extensive file review requests.
Assists in preparation of complaint trend reports.
Assists in compiling claim data for customer audits.
( ) Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
( ) Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
( ) Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Performs financial data maintenance as necessary.
( ) Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Experience:
2
years' recent experience in a call center production environment OR customer service experiences in a transaction based environment with extensive inbound/outbound phone experience REQUIRED 1 year minimum experience with Medicaid/Medicare or Health Insurance also in high volume production environment Education:
High School Diploma or GED required.
Associates degree in Business, Accounting or equivalent work experience preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
MUST HAVE - Provider Claims or Medical Billing experience - 2
recent years in a High Volume Call Center experience (please specify call amount of calls handled on resume or comments.
) - Looking for candidates with proven success in call center roles - Please do not submit candidates that have only worked short tenured roles in call centers Position
Summary:
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
Triages resulting rework to appropriate staff.
Documents and tracks contacts with members, providers and plan sponsors.
Duties:
( ) Explains member's rights and responsibilities in accordance with contract.
( ) Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
( ) Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
( ) Responds to requests received from Healthcare's Law Document Center regarding litigation; lawsuits.
( ) Handles extensive file review requests.
Assists in preparation of complaint trend reports.
Assists in compiling claim data for customer audits.
( ) Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
( ) Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
( ) Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Performs financial data maintenance as necessary.
( ) Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Experience:
2
years' recent experience in a call center production environment OR customer service experiences in a transaction based environment with extensive inbound/outbound phone experience REQUIRED 1 year minimum experience with Medicaid/Medicare or Health Insurance also in high volume production environment Education:
High School Diploma or GED required.
Associates degree in Business, Accounting or equivalent work experience preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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