Administrative Skills, Billing, Claims Processing, Customer Support/Service, Data Quality, Multitasking, Problem Solving Skills, Provider Contracting, Provider Relations, Public/Media/Press/Analyst Relations, Telephone Skills
Duration: 05 months (Possible Extension)
Location: 100% Remote
Scheduled:
Training:
Training hours are Monday through Friday 8:30 AM - 5:00 PM CST.
Work Schedule:
After all the training is completed, the hours for this position will be 10:30am-7:00pm CST.
Job Description and Role Summary:- The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues.
- The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing requests, provider contract questions or requests to update demographics.
- Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call.
- Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.
Responsibilities:- The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
- The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up.
Within a call a Claims & PR Advocate may:- Assist a member or provider with understanding how a claim has processed Verify claim status for a member or provider Educate a member or provider on billing protocols Write or correct authorizations to ensure claims are paid correctly Send claims for adjustment/reprocessing
- Request duplicate EOBs for a member or provider Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check Provide follow-up on issues by making outbound calls when necessary.
- Send resources to members and providers via email Submit a complaint on the member or provider's behalf Send handoff requests to matrix partners for escalated or complex issues
- Assist providers with contract related inquiries and demographic updates
- Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved.
Education: - Bachelor’s Degree required.
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Integrated Resources, Inc