Serves as an account representative with facility (institutional) and provider groups maximizing their ability to interact with WellCare. Manages education and issues related to claims, reimbursement, authorizations and referrals. Responsible for onsite interaction as necessary with high maintenance providers/strategic providers.
REPORTS TO: SR. MANAGER, OPERATIONS ACCOUNT MANAGEMENT
DEPARTMENT: OPERATIONS NATIONAL ACCOUNT MANAGEMENT
POSITION LOCATION: LOUISVILLE, KY 40223
- Educates providers on common billing practice errors and reimbursement policies.
- Educates and drives adoption of self service tools (EDI, Provider Portal, EMR, etc.).
- Conducts root cause analysis on claims adjudication or related issues via direct access to applicable tools
- Educate providers on service model to drive adoption and be the conduit to assist when service fails.
- Drives providers to the standard process; supplements and supports as necessary.
- Partners internally with information exchange when WellCare has failed on service.
- Conduit for provider issues that cross multiple platforms and/or result from integrations.
- Obtains signed documentation via face to face provider visit when necessary in support of recontracting lead by Network Development and recredentialing lead by Credentialling Dept. Scans and submits collected information in timely manner.
- High School or GED is required
- Bachelor's Degree in a related field; Bachelor's degree may be substituted for up to 2 years of required experience is preferred
- Required 3 years of experience in Customer Service/relationship building position that involved problem solving and critical thinking skills is required
- 1 year of experience in Physician/Hospital Billing Manager or Medical Practice Administrator is preferred
- Experience in a professional level audit and recovery operations position with experience working with claims data and inaccurate payments is preferred
Licenses and Certifications:
- Knowledge of CPT and ICD-9/10 coding
- Relationship building skills and highly developed customer focus skills
- Comprehensive knowledge of how a claim is built and paid
- Understanding of practice management operations
- Analytics or root-cause analysis experience
- Highly developed presentation skills
- Self-management skills, ability to handle rapid change and an affinity for continuous learning
- Detailed knowledge about health plan operations
A license in one of the following is required:
- Certified Coding Associate (CCA) or Certification of Medical Practice Executive (CMPE) is preferred
- Certified Coding Specialist – Physician Based (CCS-P) is preferred
- Certified Coding Specialist (CCS) is preferred
- Microsoft Word is required
- Microsoft PowerPoint is required
- Microsoft Excel is required *LI-RG1