JOB SUMMARY:

Provide specialized support to clinical staff by responding to member phone calls; facilitate problem resolution and triage calls to appropriate resource. Provide administrative and project support to the department and/or management.

ESSENTIAL JOB FUNCTIONS:

• Respond to inquiries from internal and external customers; facilitate problem resolution through research. Refer call to appropriate resources in a timely manner.
• Interact with clinical staff to obtain health care information necessary for data entry, payment authorization, or quality initiatives. Perform data entry into the medical information system and other applicable data bases.
• Prepare correspondence and survey information for clinical staff; ensure adherence to regulatory, accreditation, and departmental standards.
• Research claims and coverage data and verify eligibility for payment purposes.
• Prepare monthly and ad hoc reports to support operational needs of the division and other duties as assigned to support corporate objectives.
• Assist team with department initiatives and projects.
• Perform other duties as assigned.

QUALIFICATIONS:

Minimum Education and Experience:

• High school degree
• Two to four years experience in a medical, hospital, or third party payer setting

Preferred Education, Additional Qualifications and Experience:

• Experience in claims
• Experience in a managed care environment
• Knowledge of state and federal health regulations and accreditation standards (e.g., NCQA, URAC, DOH, DHS, CMS)
• Proficiency with Microsoft Suite of products; i.e., Word, Excel, PPT, etc

Required Knowledge, Skills, and/or Abilities:

• Knowledge of medical terminology
• Working knowledge of Microsoft Office including Excel, and Word
• General computer proficiency
• Written and verbal communications skills
• Good organization skills
• Time management skills
• Detail oriented
• Ability to research and organize data
• Ability to organize work efficiently to meet established time and quality standards

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf to view the "EEO is the Law" poster.

Other details

• Pay Type Hourly

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