First Choice Health Network - Spokane, WA

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Responds and provides follow through to customer inquiries, issues and concerns in a timely and accurate manner.

  • Processing claims types to include Institutional, Professional and Dental claims.
  • Reviews, researchs, and resolves claims in accordance with contracts and policies through the utilization of reference materials and on-line tools.
  • Processing all levels of claims procedures to include COB, SARVW, Pre-X, Adjustments and Action Grams.
  • Addresses and takes appropriate action on Action Grams received within 48 hours of receipt.
  • Consistently maintains department minimum productivity and quality standards for adjudicating claims while maintaining established accuracy guidelines.
  • Provides feedback to unit Manager regarding plan benefits and system issues.
  • Must comply with strict confidentiality of Protected Health Information.
  • Responds to telephone inquiries per established standards, policies and procedures.
  • Responds to written correspondence from customers as assigned.
  • Researches issues and takes appropriate actions to resolve.
  • Provides accurate information regarding benefits, providers, claims, referrals, eligibility, pharmacy, etc.
  • Documents (online) each contact and outcome.
  • Utilizes on line benefits, policies and procedures.
  • Other projects as assigned.

  • High School Diploma or equivalent.
  • Excellent verbal and written communication skills. Experience and training in Conflict Resolution.
  • Minimum 3 years customer service or equivalent experience. Minimum 2 years experience in a TPA or ASP environment.
  • 1 to 2 years current healthcare claims experience, preferably in a managed care environment.
  • Ability to handle multiple priorities in a sometimes stressful environment.
  • Basic computer skills/Word Processing/Windows environment preferred.
  • CPT, ICD-9 and HCPCS proficiency required.

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