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.
Please submit your resume to firstname.lastname@example.org .
Additional information about our company may be found on our website
First Choice Health Network - 23 months ago
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