In this Role you will be Responsible For
Communicate with contracted and non-contracted Providers by providing information and assistance as appropriate.
Assist Providers with interpreting Member eligibility and benefit information
Assist with general question about the existing Programs and Member benefits.
Assist with direction on the available Provider portal, including how to set up accounts, troubleshooting and navigating the website, how to submit and retrieve necessary information.
Handle claim status inquiries, researching and facilitating resolution of payment issues; provider education on remittance advice interpretation and reimbursement, and informing providers of the claims appeals process.
Work closely with the Claims Team in resolving claims discrepancies, inappropriate denials and delays in payments.
Provide providers with eligibility; process authorizations and Exception Requests
Answer questions regarding authorizations and denials
Meet NTT Call Center Standard Work and performance expectations. This includes, but is not limited to the following:
• Successful completion of Provider Call Center training,
• Active participation in continuous training,
• Follow required call scripts and QA requirements.
• Ability to handle high call volume.
Provide excellent customer service to all callers. Demonstrate a high level of patience and respect with every caller, ensuring each caller is assisted promptly and appropriately and follow Provider Call Center established call handle Quality Assurance Standards and Objectives.
· Assist the Provider Call Center or Provider Services Departments with projects, as needed.
Timely follow up with Providers on cases as needed.
Ensure the privacy and security of PHI (Protected Health Information) as outlined policies and procedures relating to HIPAA compliance.
Key Skills:
Excellent customer service skills, including ability to diffuse difficult situations.
Ability to analyze complex claims data/payments and clearly communicate findings to Providers
University degree or equivalent that required formal studies of the English language.
1+ year(s) of experience in a service-oriented role where you had to correspond in writing or over the phone with customers who spoke English.
1+ year(s) of experience in a service-oriented role where you had to apply business rules to varying fact situations and make appropriate decisions
1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
1 + year(s) of healthcare call center experience working in a health care delivery setting preferred.
*** The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.
*** All new hires will be required to successfully complete our Orientation/Process training classes and demonstrate proficiency of the material
