Insurance / Healthcare Representative
- Position will work directly with Providers, reviewing and processing Medicaid, provider enrollment applications according to DHA approved enrollment criteria, ACA, and other federal requirements and procedures.
· Primary responsibilities include Providers, reviewing and processing Medicaid, provider enrollment applications according to DHA approved enrollment criteria, ACA, and other federal requirements and procedures.
o Update and maintain accurate provider files in interchange system which includes documenting information such as a provider address(s), Social Security Numbers, Tax ID numbers, any past cancellations or sanctions, any changes to the provider file, and pay to information.
o Respond to calls or written correspondence received from providers relating to enrollment issues as needed.
o Ensure all departmental and Medicaid, WCDP, and WWWP program quality and quantity standards are met.
o Research and compile effective dateappeals for DHS.
o Perform daily verification of keyed data for accuracy and notifying appropriate PM Clerk of errors for corrections.
· The role will require knowledge of Windows based programs and a familiarity with basic office equipment; fax, printer, PC etc.
· Will be working with both DXC and State liaison each day.
Education and Experience:
- High School Diploma or equivalent; may hold 2year post-high school Degree; may hold Bachelor’s degree.
- Able to read, write and speak English proficiently
- Excellent written and oral communication skills in both languages
- 2-4+ years of working experience in customer service or related fields.
Knowledge and Skills:
- Customer service experience
- Ability to perform extensive research independently
- Healthcare/Insurance billing experiencedesired
- Office administrative experience and skill desired
- Ability to follow written policies, procedures and guidelines, and give feedback to leadership.
- Intermediate-level knowledge of operating systems.
- Self-motivated with good time management and organizational skills.
- Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
- Excellent written and verbal communication skills and customer service skills, including professional telephone skills.