Claims Provider Representative I

Claims Provider Representative I

Under general supervision, help providers understand the policies and procedures in submitting claims, and assist in solving providers’ claim problems of a routine nature to ensure they are processed and paid on a timely basis.

Position overview

• Respond and handle high-volume calls via call center queue, voicemails, emails and faxes from medical providers and others, answering their questions and assisting in the resolution of issues relating to claims submission and payment.
• Research, identify, refer, resolve and follow-up regarding problems and notify others of findings and provide recommendations for system or process improvement.
• Document all actions in Call Log and respond to open issues in a timely manner.
• Educate others regarding program information and proper medical claims billing procedures with the goal of improving and maintaining provider satisfaction.
• Communicate newly identified and potential issues to the Lead, Claims Managers, and other departments as necessary.
Secondary Functions:
• Attend Team Meetings for ongoing training and development.
• Perform other duties as assigned.

Requirements
These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience
• High School diploma, GED or equivalent required.
• Associate of Arts degree in a related field a plus
• Two (2) years’ experience working in a high-volume call center with at least one (1) in a healthcare environment.
• Medi-Cal and Medicare experience preferred.

Knowledge of:
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint
• Medicare and Medi-Cal programs.
• HCPCS, CPT, ICD-9 and Revenue coding.
• HIPAA regulations.
• Medical terminology.

Ability to:
• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Communicate effectively orally, in writing, and excellent phone skills.
• Be a self-starter.
• Independently solve problems and organize own workload according to department priorities and deadlines.

Salary and benefits
The starting salary range is $22.76 - $28.79 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:
• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)