Claims Research Specialist
Wellpath | Nashville, TN
Our Claims Research Specialist is the face of the claims department to providers and customers in contacting CCS for questions regarding claims authorization, payment and related workflows. They document calls issues, insure follow-up and proper resolution of all complaints and problems.
- Associates degree or similar medical claims experience
- Excellent written and verbal communication skills
- Three (3) or more years of medical claims investigation experience.
- Prior experience on the phones researching and resolving claims issues.
- Strongly analytical, research and problme solving skills
- None required
ResponsibilitiesReceive calls from providers and customers dealing with medical claims issues. Document each call in salesforce review/track all correspondence recieved.Resolve all claims issues by performing all necessart research and comunicate solutions in response to customer Triage issues and determine for cross-functional department involvement in resolving billing claims issues.Research and answer questions from providers, customers or sites regarding claims payment, eligibly and authorizations for services.Be warm, helpful and respectful to all callers. Demonstrate the 5H's in all interactions with others.Build, develop, and maintain relaionships with all participants (providers, customers, administrators, and sites) through claims processes education.Clearly, unambiguously and truthfully communicate with callers, internal resources and others.Understand and demonstrate mastery in understanding CCS workflows, processes and systems involved in the eligibility, authorization and claims payment processes.Utilize necessary resources and navigate systems efficiently to accurately verify eligibility, claim status, appeal status, and payment resolution.Must understand Third Party Administrating concepts.Must have strong organizational skills, problem solving and decision making skills. Knowledge in excel and Word. Ability to navigate through and utilize various PC applications. Professional interaction, active and passive listening skills.Self-direction and self-starter skills required. Be able to adequately multitask while maintaining quality and accuracy.Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.Must be alert at all times; pay close attention to details.Must be able to work under stress on a regular or continuous basis.Demonstrate esprit de corps in all areas.Perform other duties as assigned.
CCS is an EOE/Minorities/Females/Vet/Disability Employer