Job Description

Handles inbound phone calls from Veterans, VA and other customers. Performs claims research and resolution regarding both institutional and professional claims. Reviews claims and responds to Veteran questions regarding billing issues. 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: o High School diploma or G.E.D.

o 2+ years’ healthcare claims, billing or related claims area

o Good communication skills

o Call center or customer Service experience

o Knowledge of medical terminology

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

PREFERRED: o 1+ years college or equivalent experience o 1 year call center or customer service experience o Knowledge of medical claims processing/review o Managed Care experience

KEY RESPONSIBILITIES

o Utilizes various software applications in use at TriWest. o Understands procedures and processes of the VA program. o Performs claims research, including interpreting VA policies, investigating automated transactions, documenting outcomes, updating records and reporting accurately on research findings. o Resolves incorrect claims processing, calls providers for Missing claims and medical documentation to resolve Veteran billing issues. o Reviews authorizations to establish ancillary providers associated and obtain claims missing for payment. o Answers inbound calls from Veterans and providers in a timely manner. o Makes outbound calls to resolve Veteran billing issues. o Consistently displays professional and courteous service skills to internal and external customers. o Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes providing details about referrals, authorizations, claim status and billing discrepancies. o 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.

o Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information. o Documents all communications involving Veteran and provider contacts. o Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments. o Understands and utilizes the grievances and appeals process available to dissatisfied beneficiaries and providers. o Consistently meets department productivity and performance metrics. o Performs other duties as assigned. o Regular and reliable attendance is required.

Company Description

Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®! Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.