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Healthcare Claims Call Representative

VP Total Solutions Flint, MI
  • Posted: 22 days ago
  • $14 to $16 Hourly
  • Full-Time
  • Benefits: Medical

Position Summary:

This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, working with Network Development to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.

Essential Functions and Responsibilities:

  1. Meet the Department call metric standards and issues/diaries entered.
  2. Assist Providers and Members as needed with questions and concerns.
  • Answer billing/claims status questions; resolve claim issues for providers
  • Assist with pharmacy issues
  • Verify member eligibility
  • Quote benefits
  • Assist with Referrals
  1. Ongoing Provider education.
  2. Responsible for all benefits information given to Providers and Members.
  3. Participate in Departmental Projects, as appropriate.
  4. Coordinate quality improvement initiatives with Medical Management Dept., Network Development, i.e., HEDIS improvement, Provider education.
  5. Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.

Qualifications:

Required:

  • High School Diploma or equivalent certification
  • Two (2) years’ experience in a high volume call center
  • Two (2) years’ experience in a Physician front office environment

Preferred:

  • In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
  • Associate’s Degree in business, health care or related field. An equivalent combination of relevant education and experience may be substituted for the educational requirement

VP Total Solutions

Why Work Here?

Exellent contractor representation and support.

VP Total Solutions is a creative and flexible staffing firm specializing in contract to hire, long-term contract and direct placement. We have the ability to save companies thousands of dollars due to our low overhead business structure without compromising quality or quick turnaround. Healthcare, IT, Automotive, Engineering, Clerical, Call Center, Manufacturing and General labor are just some examples of the industries we focus on. We literally have thousands of resumes in our database full of candidates that could be a perfect fit for your hiring needs. This is a challenging position in a nice, clean environment with a world class company and there is plenty of room for growth! With over 60 years of experience in the staffing business, we are professionals that analyze your business and company culture to ensure a great fit at a great rate! VP Total Solutions offers Health Benefits w/Vision Insurance, Life and Disability insurance and paid holidays after 90 days of employment. We look forward to helping you with any upcoming projects or helping you manage your workforce by placing the right person in the right job!

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