As a customer service representative, I handled phone calls and chats to help resolve provider issues. I checked if prior authorization was required for claims and made sure the authorization on file was valid to prevent denials. If a third-party vendor was involved, I transferred the request to the right department.
I reviewed claims to ensure they were submitted correctly, preventing multiple submissions. I also checked if appeals were valid and sent claims for reprocessing if they were denied incorrectly. For unclear denials, I contacted the home plan for clarification.
Additionally, I confirmed patient benefits and eligibility to see if services were covered, and I verified procedure codes to avoid claim denials. My role required attention to detail and good communication to handle healthcare claims and authorizations effectively.
