Job Board

CareFirst Appeals Intake Coordinator 27845

 

Long-term contract position (it could go permanent) with CareFirst BlueCross BlueShield that is REMOTE. 

 

 $18/hr for this position while you’re on contract.

 

These positions move quickly so for a quick submittal please shoot me a Word Doc resume and provide the following info:

  1. Your full LEGAL name:

  2. Your hourly rate request:

  3. The Month/Day of your date of birth (I do not need the year):

  4. How much notice you would need to start if selected?

  5. Are you a US Citizen, Green Card, or H1B??

 

DESCRIPTION:

• Accurately logs, tracks, and processes health service appeals.


• Maintains all documentation associated with the processing and handling of appeals to comply with regulatory standards and timeframes while maintaining an accurate, complete appeals record in the electronic database.


• Performs administrative activities including, but not limited to, generating, printing, and mailing determination and authorization notification letters. Completes all associated data entry in appeals tracker and MHC system. Correctly and completely preps completed large-volume case files/records for scanning and archiving.


• Interacts with other departments including Customer Service, Claims, Provider Relations, and Pharmacy to resolve provider appeals.


• Develops and presents ideas for performance and process management improvement within the department. Notifies Supervisor or other appropriate parties of identified patterns of appeals, claim errors, configuration issues, or other systemic problems identified during appeal processing.


• Handles all Provider Appeal return mail.


• Performs special projects as needed.

PRINCIPAL ACCOUNTABILITIES:
Enrollee Service Representatives serve as Enrollee and Provider advocates who provide guidance, assistance, and education to Enrollees, caregivers, and providers answering basic questions regarding Enrollee health care needs, benefits and effectively resolve issues raised by Enrollees primarily through inbound calls.

Under the direct supervision of the Manager of Enrollee Services, the Enrollee Services Representative is responsible to:

• Provide adequate customer service to our enrollees, vendors, and providers


• Identify callers concerns and provide resolution for the inquiry


• Assist enrollees with a request to change or select a PCP (Primary Care Provider)


• Re-issue enrollee ID cards as requested


• Assist enrollees with questions related to their benefit plan


• Obtain and update demographic information


• Assist Enrollees  face to face who walk-in the office


• Assist irate callers to resolve their issue


• Assist Enrollees with filing a grievance and forwarding to the appropriate department


• Document all interactions with callers
• Interact with pharmacies when appropriate


• Identify trends with enrollees and providers that can affect daily operations


• Process return mail, enrollee cards, and packets


• Facilitate special transportation request


• Provide clarity to providers on basic claim questions


• Educate providers on internal processes for claims, authorization, and appeal/grievance submission


• Confirm the status of a claim (paid/denied)


• Direct providers to appropriate internal departments for further assistance


• Confirm eligibility and PCP assignments to providers and contracted vendors


• Follow company and department policies and procedures


• Meet department call center goals for abandonment rate, service level, and speed of answer


• Participate in community events


• Other duties as assigned


NECESSARY QUALIFICATIONS:
Required Experience/Skills/Abilities:
§ Minimum two (2) years of call center experience


§ Experience with health care benefits or DC Medicaid, Managed Care experience preferred


§ MHC preferred


§ Experience with Facility and Professional audits of claims


§ Knowledge of ICD-10 and HCPC codes, XEROX, Emdeon, and eligibility tools


§ Proficient in Microsoft Office tools (Excel, PowerPoint)


§ High-level understanding of the claims process.

Preferred:
High School Diploma or GED