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Claims Support Specialist I
2 months ago
Position Overview:
In this role, you will be responsible for investigating and addressing provider inquiries received via telephone and written communication. Your duties will include accurately assessing claims and engaging in provider-focused meetings and initiatives.
Key Responsibilities:
- Address provider inquiries through phone communication, analyze policy matters, review Explanation of Payments (EOPs) and claim histories, propose solutions, and implement approved resolutions.
- Investigate and relay outcomes to providers regarding Claim Inquiry Forms (CIFs), claim tracers, and general claim correspondence within set deadlines.
- Adhere to established policies and procedures, including claims operating instructions and regulatory guidelines, while resolving claims and related issues.
- Engage in provider meetings to collaboratively address claim-related challenges.
- Provide feedback to management regarding procedural improvements that could enhance operational efficiency.
- Document daily production metrics and related activities, submitting all logs and reports to the Claims Customer Service Supervisor.
- Meet established performance metrics for production and call handling.
- Contribute to special projects and assignments as needed.
- Assist in the resolution of CIFs as required.
- Perform additional duties as assigned.
Qualifications:
Education and Experience:
A high school diploma or equivalent is required; one year of experience in claims processing within an automated environment is preferred, or an equivalent combination of education and experience.
Special Skills, Licenses, and Certifications:
Familiarity with CPT, HCPC procedure coding, and ICD-10 diagnostic coding is essential. Knowledge of medical terminology is preferred. Proficiency in using coding reference materials for accurate information is required. Typing speed of 30 words per minute and competent use of a 10-key calculator are necessary.
Performance-Based Competencies:
Strong written and verbal communication skills are essential. The ability to exercise sound judgment within the scope of authority and manage sensitive issues with discretion is crucial. Good organizational skills and the ability to complete tasks accurately within designated time frames are required.
Work Environment and Physical Demands:
The role requires the ability to operate a computer keyboard. More than 80% of work time will be spent in front of a computer monitor. When necessary, the ability to move, carry, or lift objects weighing up to 25 lbs is required.
Employee Expectations:
- Deliver exceptional service to clients.
- Encourage teamwork and collaboration among colleagues.
- Maintain safe working practices.
- Comply with company policies and procedures, which may be updated periodically.
Compensation:
The hiring range for this position is $34.00.
Disclaimer:
The duties, responsibilities, skills, functions, experience, educational factors, and requirements outlined in this job description are representative and not exhaustive. The employer reserves the right to modify this job description at any time and may require employees to perform additional tasks as business needs evolve.
