Adjudication, Billing, Call Centers, Child Support, Claims Processing, Coding Standards, Compensation and Benefits, Content Management Systems (CMS), Customer Support/Service, Flexible Spending Accounts, Health Insurance, Healthcare, High School Diploma, Hospital, Identify Issues, Insurance, Life Insurance, Mail Processing, Medical Billing, Medical Terminology, Organizational Skills, Regulatory Requirements, Resolve Customer Issues, Staff Policies, Trend Analysis
Here’s what you will be doing:
- Resolves customer service issues, expedites the adjustments and follow ups to ensure the resolution; adjudicates required claim adjustments identified through communication with members, employees and clients
- Updates and maintains information and knowledge regarding plans and benefits administered by the Insurance Department; educates members and external customers on policies and procedures related to members’ health care program
- Interprets member eligibility and coverage through knowledge benefit plans, Contract Heath Service programs, claims and departmental procedures needed to assist Tribal members, employees and other clients; initiates check tracers and investigate claim payment irregularities
- Collaborates with the FCPHWC, ICW, Child Support, Economic Support, Elderly, and other FCP Departments to assist in providing Tribal members information needed to ease access to care; assists in the development and communication of resolutions, procedures and policies to internal staff, as requested
- Performs the role as Health Care Coordinator for the Potawatomi Cares Plus program; identifies trends/issues that emerges in calls/correspondence, and informs Supervisor or Director
What you need to be successful:
- High school diploma or GED
- Knowledge of medical terminology, insurance, and billing; NCCI and CMS coding standards
- Knowledge of applicable federal, state, county, and local laws, regulations, and requirements
- Knowledge of all FCPC benefit plans, health programs, eligibility, claims, and departmental procedures needed to assist employees and tribal members
- Must successfully pass all applicable background checks and drug screens
Preferred Qualifications:
- Two (2) year degree in health related or communication field, including a course in medical terminology preferred
- Three (3) years call center customer service experience in a health insurance, physician group practice or hospital setting preferred
Benefits you’ll love:
- Approximately 5 weeks of paid time-off annually
- 3 weeks of paid holidays
- Premium free health insurance
- Flexible spending accounts
- Short-term disability
- Life insurance
- 401k with match
F
Forest County Potawatomi Community