Job Description

MEDICAL CLAIMS CALL CENTER REPRESENTATIVE - ONSITE - EL PASO, TX

JOB SUMMARY

Handles inbound phone calls from Providers, VA, and other customers. Reviews claims and responds to billing questions. Provides updates on claim status, including notification that claims are in process, pending for more information, and denied. Works in a detailed, fast-paced, and repetitive production environment. Interacts with customers in a professional, formal manner where the focus is on completing the task pleasantly and with high quality and accuracy.

EDUCATION & EXPERIENCE

REQUIRED

High School diploma or G.E.D. o

1+ YEARS’ HEALTHCARE CLAIMS, BILLING OR RELATED HEALTHCARE AREA

Good communication skills

CALL CENTER OR CUSTOMER SERVICE EXPERIENCE

Proficient with Outlook, Microsoft Excel, the Internet and on-line systems

PREFERRED

1+ years college or equivalent experience

1 year call center or customer service experience

Knowledge of medical claims processing/review

Medical terminology knowledge

KEY RESPONSIBILITIES

Utilizes various software applications in use at Company o Understands procedures and processes of the VA program o Answers inbound calls from providers in a timely manner

Answers questions related to the status of providers’ claims

Conducts basic claims history research to answer provider questions

Documents all communications involving provider contacts

Escalates complex claims issues for further review

Consistently displays professional customer service skills to internal and external customers

Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI). PHI is any information about health status, or healthcare services that is linked to an individual

Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information o Consistently meets department productivity and performance metrics

Performs other duties as assigned o Regular and reliable attendance is required

COMPETENCIES

TECHNICAL SKILLS

Proficient data entry skills; Ability to achieve a Meets Expectations rating or higher on monthly production bonus scorecard

TEAM-BUILDING / TEAM PLAYER

Requires little dependence on others to complete the work

PROBLEM SOLVING / ANALYSIS

Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Cautious decision making is required.

ORGANIZATIONAL SKILLS

Ability to have strong focus on repeatable, very high quality results.

MULTI-TASKING / TIME MANAGEMENT

Prioritize and manage actions and requirements within a high volume, high stress environment.

INFORMATION MANAGEMENT

Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

INDEPENDENT THINKING / SELF-INITIATIVE

Critical thinkers with ability to provide strong follow-up to ensure that work quality and attention to detail remain very high.

HIGH INTENSITY ENVIRONMENT

Ability to function in a fast-paced environment while maintaining focus and control of workflow.

EMPATHY / CUSTOMER SERVICE

Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

COPING / FLEXIBILITY

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

COMPUTER LITERACY

Ability to function in a multi-system Microsoft environment using Word, Outlook, Company Intranet, the Internet, and department software applications.

COMMUNICATION / PEOPLE SKILLS

Ability to speak with great specificity and knowledgeable detail about areas of responsibility.

COMMITMENT TO TASK

Ability to conform to established policies and procedures; exhibit high motivation.

WORKING CONDITIONS

Ability to cover any work shift Monday - Friday and Sunday, with no travel

Ability to work overtime, if needed o Works within a standard office environment o Extensive computer work with prolonged sitting and wearing of headset o A VA-approved security clearance may be required