Vacancy caducado!
POSITION PURPOSE:
To educate providers and members and maintain files regarding Medicare Advantage programs. Be an advocate on behalf of all customers. Initiate communication with members and participate in outreach activities. Accurately respond to written and verbal inquiries received by Medicare Advantage members and providers.Required Experience: One year call center, customer service, claims processing, medical billing or health insurance industry experienceRequired Knowledge, Skills and Abilities (KSAs):
Skills:
Data entry
Written and verbal communication
Personal computer skills to include application, intranet and internet navigation
MS Office Suite, to include Word, Excel, OutlookAbility to:
Work under limited supervision in an effective and professional manner
Work scheduled shift which may include evening, weekday, weekends, and/or holiday schedulingPreferred Qualifications:
Medicare and Managed Care health plan experience
ICD-9 (preferably ICD-10) and CPT coding
Medical terminology
Bilingual
Knowledge of NDC codes and pharmacologyPRIMARY ACCOUNTABILITIES:
Act as member advocate to identify needs and concerns of members, and work with management to resolve.
Conduct enrollment verification, inquiry responses, disenrollment and enrollment processes.
Assist with new member education to include prescription plan education as required.
Issue letters, member handbook, educational material, and program changes to members.
Participate in review of developed Medicare Advantage written communication.
Maintain member files, conduct research and inquiries.
Understand and follow appropriate privacy rules when speaking with members.
Assist members with Primary Care Providers and other provider choices.
Communicate with members and internal departments in a wide variety of inter-related activities to include benefit and service explanations.
Maintain production levels based upon contact volume, quality and service expectations as outlined by management.SECONDARY ACCOUNTABILITIES:
Assist in the identification of potential third-party payers.
Identify and/or process grievances and appeals as assigned complying with Medicare Advantage regulations.
Conduct audits, as requested.
Perform other duties as requested by the Supervisor.
Vacancy caducado!