[Hiring] Provider Services Advocate @GuideWell Source

Role Description

This role involves responding to Medicare Part A and/or B telephone and/or written inquiries from the Medicare provider community regarding Medicare coverage guidelines and policies.

• Engage in dialogue with all customers using a customer-friendly tone.
• Respond to each customer's need and request ensuring positive and productive encounters.
• Use good verbal and written communication during each customer encounter.
• Embrace diverse backgrounds and tailor responses for customers with varying knowledge of Medicare rules.
• Draft clear, concise, and accurate responses to written inquiries.
• Access multiple systems to research customer problems and record inquiry types.
• Research CMS and company websites to provide knowledge and education to customers.
• Access the Interactive Voice Recognition (IVR) and Internet Portal systems as needed.
• Review claims processing systems to identify specific claim edits and audits.
• Analyze claim edits and audits to determine reasons for claim denials.
• Review debt recovery systems to troubleshoot pending accounts receivables.
• Review local and national medical coverage policies to troubleshoot claim denials.
• Address and determine resolution to other customer issues including pending appeals and prior authorization requests.

Qualifications

• High School Diploma or GED
• 1 year of related work experience (call center, customer focus, or claims experience)
• Demonstrated internet and/or PC software navigation
• Demonstrated strong problem solving and decision-making skills
• Demonstrated good listening and strong verbal communication skills

Requirements

• Post-secondary education/classwork (preferred)
• Experience in the insurance industry or medical coding (preferred)

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave