Medicare Claims Service Representative

Description :

This position is responsible for responding to Provider telephone inquiries regarding the D-SNP CareConnect Claims, researching and responding to the D-SNP claims issues raised, performing regular monthly meetings with the provider community, assisting with provider workshops preparing educational materials and providing suggestions for the Claims Bulletin and EOB inserts (fliers) when necessary; research and resolve provider disputes, higher level reviews and stay current with all policies and procedures.

What You Will Do :

• Intake and respond to all provider telephone inquiries
• Log all calls received and initiated into the Provider Call Tracking system within QNXT and maintain accurate accounts of conversations within the log for tracking purposes
• Research, adjudicate and respond to all claims issues related to telephone inquiries, disputes, NCM and provider emails in a timely manner
• Send provider EOP’s when requested
• Review test Explanation of Payment (EOP’s) for accuracy of claims payment, denials and suspends
• Monitor provider billing errors, trends and provide courtesy calls to providers, when possible, problems or trends are detected
• Assist with pended claims when necessary
• Conduct meetings with Providers that are experiencing a high volume of denials, that have new billers, or any provider requesting assistance with any type of claim related issues. Compose letters to those providers visited. Conduct and outline discussions during the meeting and perform any follow up that may have been required
• Analyze provider’s claims to assure the most accurate, timely and efficient processes are occurring and work directly with the providers where improvement may be needed
• In conjunction with the Claims Service Supervisor, prepare and occasionally present at the Claims Provider Workshops
• Complete special projects within the department when necessary
• Complete processes and timelines required by CMS, AB1455, and DHCS Regulations
• Other duties as assigned

You Will Be Successful If :

What You Will Bring :

About Impresiv Health :

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!