Wexford Health Sources, one of the nation's leading innovative correctional health care companies, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality. For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.
At Wexford Health our philosophy is that health care should not be considered a luxury for anyone. We simply care for those in need and the corrections environment is our venue.
Wexford Health has an exceptional opportunity for a full-time Claims-Customer Service Representative to join our team of healthcare professionals at our corporate office in Pittsburgh, PA.
The Claims-Customer Service Representative provides customer service support and processes claims in a manner that ensures effective and efficient department operations.
DUTIES AND RESPONSIBILITIES
- Answers incoming customer service calls from providers and facilitates the handling of requests for information and assistance.
- Efficiently and effectively responds to incoming claims calls and inquiries; routes calls to other staff members as appropriate.
- Process paper claims including complex HCFA 1500, UB04 and any successor forms.
- Examine and research information including authorizations, payments, denials, and resolve outstanding issues to meet client and provider expectations.
- Resolve simple issues and, through established work processes, forward complex issues as appropriate to other members of the claims and provider contracting departments.
- Identify and communicate opportunities for process improvement to management and co-workers.
- Deals professionally with confidential information.
- Educates providers on Wexford Health and appropriate contacts within the company for claims inquiries, utilization management, contract status, and other questions that may arise.
- Maintains logs and keys information into database(s) as necessary for data collection and tracking purposes.
- Perform department related research.
- Assumes other duties as assigned and directed.
REQUIRED EDUCATION AND SKILLS
- High school diploma or equivalent.
- 2+ years customer service and medical claims processing experience.
- Service orientation: ability and willingness to calmly and effectively assist customers and represent Wexford Health in a professional manner at all times.
- Previous health care related customer service experience with health care products and/or medical terminology.
- Ability to follow general directions and make adjustments to fit specific situations as needed.
- Initiative: takes appropriate action in the pursuit of individual, group, and organizational objectives, before being asked by others or forced by circumstances.
- Must be a team player.
- Strong attention to detail.
- Approaches changes in a positive manner.
- Excellent oral and written communication skills; excellent interpersonal skills
- Proficiency in Microsoft Word, Power Point, Excel and Microsoft Access database entry
- Experience with Office Equipment (fax, copier, computers, postage machine, folder)