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Provider Inquiry Rep-Provider Inquiry - Full Time - Days

Company: ProMedica
Location: Maumee
Posted on: November 22, 2021

Job Description:

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA - the National Committee for Quality Assurance - for our Ohio HMO, Elite and Advantage products. We're also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website Accountability Objective Investigate and provide answers to inquiries from participating and non-participating hospitals, primary care and specialty physicians, ancillary and allied health care professionals regarding claim status, claim payment, referral confirmations and facilitations, authorizations, appeals, member benefit and eligibility. Principal Accountabilities 1. Resolve all inquiries (telephonic, portal, webmail, written and faxed) accurately from both participating and non-participating providers regarding processed and unprocessed claims, member eligibility, benefits, referral confirmations and facilitations documenting by using contact service form or other approved method. 2. Communicate to providers appropriate claims filing requirements including, but not limited to, use of proper billing forms, coding requirements, timely filing limitations, and appeal processes. 3. As a result of provider claim inquiries, identify those claims that require adjustments. Forward adjustment requests in a prompt and accurate manner to the Claims Department for adjudication. 4. In response to member inquiries, contact providers in a timely manner to problem solve issues related to inappropriate billings, assuring the contractual obligations of the providers are met. 5. Provide support to internal customers (Member Services, Utilization/Case Management, Provider Relations, etc.) regarding claim/member billing issues to assure member/provider satisfaction and to meet regulatory compliance standards. 6. Meet specific telephone and contact service form performance standards as indicated in the department's quality indicators. 7. Cooperate, as needed, intradepartmentally as well as interdepartmentally, and perform all other duties as assigned to support the overall operations within the Provider Relations Department. Job Requirements * High School GED is required. Bachelor's degree in Health Services is preferred. * One to three years experience in one or more of the following areas: HMO/PPO customer service, claims submission and/or processing (AMISYS database), medical terminology, medical billing, CPT, HCPCS, ICD-10, and DRG coding. * Demonstrate planning, organizational, analytic and problem solving skills required, with the ability to handle multiple priorities. * Strong customer service skills required. * Effective communication (oral, written, & interpersonal) skills required. * Ability to move between company workstations. * Experience in using microcomputers for spreadsheets and word processing preferred. * Ability to communicate on telephones ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact Equal Opportunity Employer/Drug-Free Workplace Employee Exemption Type Non-Exempt Job Type Full Time Budgeted Hours / Pay Period 80 Shift Type Days Shift Hours 8 hours Weekends N/A On-call Requirements Call Not Required Additional Schedule Details This position can be filled in any one of Paramount's multiple offices. Paramount has 5 office locations: Cincinnati, Ohio Columbus, Ohio Maumee, Ohio Toledo, Ohio Warrensville Heights, Ohio Evansville, Indiana

Keywords: ProMedica, Toledo , Provider Inquiry Rep-Provider Inquiry - Full Time - Days, Other , Maumee, Ohio

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