HEALTHCARE PROVIDER ADVOCATE (Call Center)
- Providing the member's insurance eligibility details, including the status of their insurance, as well as the start and end dates. Explaining the member's eligible benefits, including copay, coinsurance, deductible, and out-of-pocket maximum. Informing claim status, whether it is paid or denied, and the reason for the denial. Providing updates on the status of the appeal, including the reason it is upheld or not. If an appeal is denied, explaining the reason and what needs to be submitted for reconsideration. Creating authorization on the member's behalf.
MEDICAL RECORDS RETRIEVER
- Provider cleanup involves researching each provider’s location to find out if they have a centralized site where patient medical records can be accessed. We contact each location to confirm their fax number and check if they use an electronic medical records (EMR) system for retrieving charts. After verifying all locations, we send out medical record requests that clearly specify the documents or measures needed. Once the patient charts are received, whether through fax, email, mail, or EMR, we carefully review and clean them by checking for missing information, fixing errors, removing blank pages, correcting orientation, and getting rid of any duplicate or inaccurate data from both electronic and paper records.
