-Provides excellent customer service to Providers and Members(Inbound/Outbound)
-Able to verify Member's Eligibility, COB & calling other insurance for confirmation and Discuss benefits under Member's plan.
-Knowledgeable of basic guidelines on how to bill CMS-1500 &UB-04 claim form.
-Knowledgeable to discuss Claims payment information, Claims denial and Rejections on the Explanation of Payments(remittance) and providing possible options to correct claims.
-Knowledeagble of Appeal/Dispute process and understand Timely Filing guidelines.
-Able to check Authorization requirements, status, and reason for denial.
-Knowledagble of Coding denials(Common denials such as Ices/iHealth)
-Knowledgable of HIPAA rules & guidelines.
-Answering inquiries through WebChat, trouble-shooting, & walk-through Providers in Portal website.
-Able to discuss Provider's contract, checking Provider's demographic change & sending Provider Relations Callback Request.
-Do Balance Billing between Providers/Members to confirm if the bill processed correctly based on the member's eligibility & financial responsibilities.
-Familiar with using Xcelys & Webstrat for pricing.
