Provider Services Advoc-Prior Authorization (Novitas)

GuideWell Source

32d • Remote

About The Position

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services. SUMMARY STATEMENT 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.

Requirements

• 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

Nice To Haves

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

Responsibilities

• 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.
• Access multiple systems to research customer problems and record inquiry types.
• Research CMS and company websites to provide knowledge and education to customer 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.
• 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.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED