Job Summary
Ensures accurate, timely maintenance, and synchronization of critical provider and or authorization data within provider/authorization databases and Facets. Researches and resolves Veterans’ claims customer service inquiries. Accesses and utilizes multiple software applications, applies business rules and knowledge of provider and or authorization processes. Communicates with internal and external customers by phone and email to clarify data and follow up on issues. Works under timelines while meeting accuracy and production targets.
Please apply directly on our website at https://www.triwest.com
Education & Experience
Required:
High School Diploma or GED
2+ years in customer service, dispute resolution, provider data or similar experience in health care industry
Experience in a fast-paced production environment Experience working with computer databases or information management systems
Experience with Microsoft Word, Excel and Outlook
Preferred:
Experience in claims or provider services Experience in in billing or collections
Key Responsibilities
Investigates and analyzes claim, authorization, and provider data errors; summarizes and identifies resolutions Responds via phone to Veterans and Providers on claims customer service inquiries
Collaborates with various team members to execute resolutions
Manages and prioritizes daily workflow queues to ensure timeliness standards are met
Reviews large amounts of complex information from multiple sources
Validates all appropriate data is supplied with health care claim
Reviews provider and/or authorization data to ensure accuracy
Contacts providers, requesting data updates or missing documentation for claims payments
Researchs and resolves claims disputes related to Other Health Insurance Collaborates with Claims sub-contractor to build or update authorization and provider records in Facets
Certifies new providers to ensure licensure and credentials are valid
Identifies and reports any potential quality or fraud issues to management
Manages follow-up of all correction requests to completion
Practices professional and concise communication in writing and by phone
Performs other duties as assigned
Regular and reliable attendance is required
Working Conditions:
o Favorable working conditions in a climate controlled office space; must be available to cover any work shift; works within an office environment with minimal travel required; level II IT security clearance.
o Extensive computer work with prolonged sitting