Jan 18, 2020
WellCare Health Plans The incumbent is responsible for the processing all inbound provider calls for Medicaid, Medicare and Health Exchange lines of business. This position requires general knowledge of claims processing, authorization processes and provider benefits. This position operates out of a phone queue and provides exceptional quality customer service to all providers. Essential Functions: Work within a call center environment to process incoming and outgoing telephonic contacts with providers. Adhere to workforce management schedules in order to ensure departmental goals are met. Conduct inbound telephonic contact with providers in a professional manner and maintain phone stats according to departmental goals. Assist Medicaid, Medicare and HIX providers with identified needs during telephonic contacts. Determine if procedures require prior authorization by checking CPT codes at the request of providers. Assist providers by entering authorizations over the phone, when applicable. Fax processed authorization requests back to appropriate provider offices. Provide regular or complex claim status to providers over the phone. Run check tracers at the request of providers for lost or expired checks. Educate providers on MHP policies and procedures regarding access to care, grievance and appeal process, eligibility process, HIPAA, rights and responsibilities, and fraud, waste and abuse. Educate providers on Meridian Health policies and procedures regarding access to care, grievance and appeal process and eligibility process. Consistently demonstrates compliance with HIPAA regulations, professional conduct and ethical practice. Provide excellent customer service to providers and internally to all Caidan Management Staff. Remain updated on all provider policy changes made by MHP, the State, or accrediting entities. Perform accurate data entry into MHP systems and software programs. May be required to work holidays and/or observed holidays as requested by leadership. Perform other duties as assigned. Additional Responsibilities: Candidate Education: Required A High School or GED Preferred A Bachelor's Degree in a related field Allied Health, Business Administration (with a focus in Health Services Administration), Health and Fitness Management, Health Sciences (with a focus in Behavioral Health), Health Services Administration, Healthcare Administration, Healthcare Management, Nursing, Nutrition, Public Safety, Pharmacy, Psychology, Public Health or Social Work. Candidate Experience: Preferred 1 year of experience in customer service experience or healthcare industry Candidate Skills: Intermediate Demonstrated written communication skills Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Ability to work as part of a team Intermediate Ability to work independently Intermediate Ability to work in a fast paced environment with changing priorities Intermediate Demonstrated organizational skills Intermediate Other Ability to remain calm under pressure Intermediate Other Ability to work overtime as required Licenses and Certifications: A license in one of the following is required: Technical Skills: Required Intermediate Microsoft Outlook Required Intermediate Microsoft Word Required Intermediate Microsoft PowerPoint Required Intermediate Microsoft Excel Preferred Intermediate Other Knowledge of PC environment Languages: About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. WellCare is a Fortune 500 company that employs nearly 9,000 associates across the country and was ranked a ''World's Most Admired Company'' in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.
Professional Diversity Network Detroit, MI, USA Full-Time