Provider Inquiry Reconsideration Requests Representative
Where
- Long Beach, CA
What you'll be doing
- Handles written response to incoming reconsideration requests from providers and outside agencies. Enters provider demographic and contract affiliation information into the health plan system. Researches and documents inquiries and proactive research in a thorough, professional and expedient manner. Completes appropriate documentation for tracking/trending data. Composes correspondence to reflect accurate resolution information in a clear, concise, grammatically correct format. Maintains tracking system of correspondence and outcomes of request; maintain organized and accurate files. Monitors each request to ensure all internal and regulatory timelines are met. Communicates with provider service representatives regarding relevant provider issues. Trains other representatives in the department. Serves as liaison with other cross departmental projects with provider services and member services. Serves as project leads on specific, complex, multi dimensional projects assigned by director of provider inquiry R&R.
What your background should be
- 3 years experience in a managed care setting. CPT and ICD-9 coding, data entry, and 10-Key experience. Knowledge of medical terminology, CMS claims coding guidelines, and provider contracts. Comprehensive knowledge of healthcare customer service. Good MS office knowledge (outlook, word, and excel). Strong organizational skills. Excellent problem solving skills. Ability to work in multi disciplinary teams and the ability to perform independently while handling multiple projects simultaneously. Excellent verbal and written communication skills. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with health insurance portability and accountability act (HIPAA). Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Required Schooling / Training
- High school diploma or equivalent GED
Who is the client company
- Concern about healthcare services.
- If you are interested in this position, send your resume to apply@kochdavis.com
