Coordinates and documents provider inquiries. Researches and assists Operations Account Representatives with resolution of claims inquiries for the Medicare and Medicaid lines of business regarding reimbursement issues, health plan payment methods, benefit coordination and eligibility/enrollment operations.
REPORTS TO: SR. MANAGER, OPERATIONS NATIONAL ACCOUNT MANAGEMENT
DEPARTMENT: OPERATIONS NATIONAL ACCOUNT MANAGEMENT
POSITION LOCATION: LOUISVILLE, KY 40223 OR BOWLING GREEN, KY 42101
- Serves as primary intake point for all provider issues and logs all provider inquiries.
- Supports the Operations Account Representatives to resolve claims and payment issues.
- Applies a comprehensive knowledge of claims processing, provider contracts and contract configuration to escalated provider inquiries.
- Thoroughly researches escalated issues and takes appropriate action to resolve them within established service level agreements, WellCare best practice and quality standards.
- Complies with all corporate and Provider operations policies, procedures and workflows.
- Performs other projects as assigned
- High School or GED is required
- Bachelor's Degree in a related field Bachelor's degree may be substituted for 2 years of required experience
- 2 years of experience in researching and resolving operational issues is required
- Experience in a healthcare environment with technical proficiency in Claims, Configuration or Operations with experience working with claims data and inaccurate payments is preferred
- Knowledge of healthcare delivery
- Demonstrated analytical skills
- Demonstrated organizational skills
- Demonstrated problem solving skills
- Analyze and interpret financial data in order to coordinate the preparation of financial records
- Demonstrated time management and priority setting skills
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Ability to understand, interpret and communicate provider contracts,
- Ability to understand, interpret and communicate Medicare and Medicaid contracts
- Ability to understand regulatory guidance as it relates to provider reimbursement
- Ability to follow direction
- Strong critical thinking skills
- Proficiency with professional claims, configuration and/or provider contracts
- Microsoft Access is preferred
- Microsoft Excel is required
- Microsoft Outlook is required
- Microsoft Word is required
- Microsoft PowerPoint is preferred