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Provider Service Representative
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Full-time
- On-site work may be requested if employee performance needs attention, internet issues or power outages that may occur.
- Inbound call center responsible for the proper and courteous handling of provider contacts regarding complex benefits, authorizations, claims resolution, provider enrollment, policies, national and organizational billing guidelines, and other provider concerns by directing, educating, and facilitating resolution via phone.
- Receive, service, and resolve provider inquiries, questions, and complaints within all established processes and procedures via phone for Level 1 queues as assigned—including calls pertaining to eligibility, benefits, authorization, claims, pre-service and post service provider appeals, contracting and credentialing, EDI issues, or general provider assistance for Medicaid plans and Medicare plans while maintaining established individual productivity metrics.
- Leverage provider-specific acumen regarding review of coding and billing guidelines for common and specialty claim submissions, Medicare NCD & LCD guidelines, medical policies, familiarity with EDI claims and eligibility files, and other familiarity with provider enrollment and revenue cycle processes.
- 1 year of relevant experience Medical billing, coding, insurance environment relevant to benefits, authorizations, provider contracting, claims processing, and/or managed health care.
Expired 18 days agoInactive Job
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