Job Description

POSITION SUMMARY:

The selected Candidate will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. They will assist in providing linkage to the Medical Management Department for authorization of services. They are 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.

MINIMUM REQUIREMENTS: 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.

Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts). This is a 120 day contract-to-hire position. Compensation for the contract portion of the engagement will be similar the direct hire rate.

Company Description

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!