[Hiring] Provider Services Advocate @GuideWell Source

Role Description

Responds to Medicare Part A and/or B telephone and/or written inquiries from the Medicare provider community which includes billing offices, medical societies, provider consultants, Managed Care Organizations, attorneys, etc. regarding Medicare coverage guidelines and policies covering a wide range of topics to include provider enrollment, Medicare appeals, debt recovery, claim payment information, telephone reopening requests, prior authorizations, and general coverage for multiple provider specialties.

Essential Responsibilities

• Customer Service: (50%)
  • Engage in dialogue with all customers using a customer-friendly tone even when challenged with overly aggressive customers.
  • Respond to each customer's need and request and ensure each customer's encounter is positive and productive.
  • Use good verbal and written communication during each customer encounter and never use jargon and slang.
  • Embrace diverse backgrounds and understand the needs of those customers who may not have as extensive knowledge of Medicare rules and regulations. Tailor responses to ensure customers receive the maximum benefit when calling Medicare.
  • May draft clear, concise, and accurate responses to written inquiries.
• Research and Problem Identification: (25%)
  • Access multiple systems to research customer problems and record inquiry types.
  • Research CMS and company websites to provide knowledge and education to customers on additional resources which can be used in the future.
  • Access the Interactive Voice Recognition (IVR) and Internet Portal systems as needed to help educate customers on self-service options that are available to them.
• Problem Solving and Analysis: (25%)
  • Review claims processing systems to identify specific claim edits and audits applied on claims.
  • Analyze claim edits and audits to determine reasons for claim denials.
  • Review debt recovery systems to troubleshoot reasons for pending accounts receivables and the generation of overpayment demand letters. Review and analyze data to determine reasons for overpayments.
  • Review local medical coverage and national medical coverage policies in order to troubleshoot reasons for claim denials and reductions.
  • Review other systems to address and determine resolution to other customer issues to include pending appeals, aged claims, prior authorization requests, and Medicare Secondary Payer.

Performs other duties as the supervisor may, from time to time, deem necessary.

Qualifications

• High School Diploma or GED
• 1 year of related work experience; this includes experience in 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

Preferred Qualifications

• Post-secondary education/classwork
• Experience in the insurance industry or medical coding or related work experience

Requirements

• The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
• Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.
• Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

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

Company Description

We are an Equal Opportunity/Protected Veteran/Disabled Employer.

This opportunity is open to remote work in the following approved states: AL, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL and PA in-office and hybrid work may also be available.