Provider Claims Service Specialist (Finance)

SUMMARY:

Investigates and resolves processing issues for BlueCard Host Program claims that are identified through direct and indirect inquiries received from IBC Host providers.

 

DUTIES AND RESPONSIBILITIES:

 

•         Provides prompt, professional, courteous and quality service to contracting facility providers within IBC's five county and contiguous service area.

 

•        Achieves and maintains the knowledge and skill level required to provide accurate information and superior support in response to provider inquiries received via correspondence, telephone and/or during facility site visits.

Identifies and documents the root cause of inquires and initiates appropriate action for resolution, up to and including claim and/or adjustment processing.

Provides response to general questions within 48 hours of initial inquiry Provides daily feedback, status updates and targeted resolution date for more complex issues.

Prepares and submits provider status reports to hospitals and/or internal departments in support of inquiry related projects, including analysis, update and resolution.

 

•         Effectively interfaces with IBC Host providers, IBC operational divisions, (i.e., Hospital Services, Finance, Claims Operation Reporting and Provider Services) and with other Blue Home Plans in the resolution of Host provider service issues.

Demonstrates and conveys a clear understanding of the Host BlueCard process. Educates providers regarding the BlueCard Program.

Coordinates with other Blue Home Plans to expedite problem resolution

 

•         Employs appropriate processes and procedures to support inquiry resolution and achievement of departmental goals:

Creates and updates Host Profile for assigned AR facility

Conducts routine meetings with providers to review issues/concerns Documents provider issues

Maintains an accurate and current inventory list of problematic claim submissions Attends internal and external meetings relating to assigned AR facility

Alerts department management of potential problems Coordinates and supports activities for Host Escalation

Works closely with management team to assist with resolution of provider related issue.

 

EDUCATION AND EXPERIENCE:

 

•         High School Diploma

•         Two to four years work experience performing various tasks related to Member Service functions, i.e., telephone servicing and claims processing.

 

•         Knowledge of claims processing systems (membership, providers and claims adjustments)

•         Experience working with providers and members.

•         Ability to accurately perform research analyzes, determine root cause and determine appropriate action.

•         Thorough understanding of medical terminology, procedure codes and diagnostics.

•         Strong oral and written communication skills necessary.

 

 

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

 

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.