- Utilizes ACD phone lines to manage incoming calls and inquiries.
- Provides high level of customer service for all internal or external customers thru telephonic, email and fax.
- Demonstrates dependable work ethic.
- Manages confidential client information with discretion and good judgement in accordance with department and company guidelines.
- Identifies problems, provides solutions and resolves promptly, escalating more complex problems appropriately.
- Responds to written or verbal provider inquiries relating to our bill review analysis.
- Analyzes problems using problem solving methodology skills to determine root cause; communicates and implements solutions.
- Types, photocopies, faxes as necessary.
- Create reconsiderations for processing.
- Responsible for performing technical review of more complex medical bills, including but not limited to modifiers, anesthesia, & psychiatric.
- Responsible for analyzing complex billings for multi-state Workers Compensation medical claims to determine appropriateness of services billed.
- Responsible for making bill review processing determination according to rules and regulations and/or third-party partner.
- Evaluates medical bills and corresponding EOR's for accuracy and compliance with state mandate fee schedule(s) and our business rules and guidelines.
- Reviews inpatient hospital, outpatient hospital, and multiple surgery billings.
- Reviews, analyzes, adjusts and releases queued bills in an accurate and timely manner.
- Refers to reference library of fee schedules, CPT, ICD-CM, HCPCS, and other industry publication to support findings.
- Processes reconsiderations, as needed.
- Phone backup to Provider Relations Team as may be needed.
- High School Diploma or G.E.D. required.
- Completed coursework or enrolled in Medical Insurance Billing and Coding
- Certificate in Medical Billing, required
- Minimum of three-year general office experience including answering inquiries over the phone or equivalent relevant experience that would provide the required skills, knowledge, and abilities.
- Two years as a Provider Relations Specialist I.
- Three years' experience in an insurance organization with two years demonstrated technical knowledge in workers' compensation medical bill review or other relevant experience, which provides necessary skills, knowledge, and abilities.
- Excellent customer service skills.
- Excellent telephone etiquette.
- Knowledge of multi-functional phone system.
- Ability to obtain pertinent and thorough information from customers.
- Knowledge of computers and spreadsheet software.
- Ability to type 40 wpm accurately
- Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
- Ability to perform mathematical calculations with the ability to use a ten-key pad with accuracy.
- Ability to multi-task, i.e., interact on telephone while entering data.
- Ability to manage work with minimal direction.
- Excellent oral and written communication.
- Demonstrate attention to detail.
- Ability to consistently meet or exceed daily production and quality standard for this position.
- Working knowledge, experience, and ability to process bills using state medical payment methodologies.
- Ability to use independent discretion to make choices on proper reimbursement.
- Thorough knowledge of Worker's Compensation multi state medical fee schedules, Medical guidelines, medical terminology and CPT/ICD-CM.
- Basic knowledge of Workers Compensation Act.
- Background in Workers Compensation preferred.
- Degree or Certification in Medical Coding
- Experience on an ACD telephone system.
-
Business Operations Specialist I/II
2 days ago
Emergent Holdings Lansing, United StatesJob Description · SUMMARY: · Responsible for performing tasks for multiple divisional/regional directors, managers and supervisors which may be highly confidential and sensitive utilizing considerable independent judgment. Performs administrative work, including, organizing, sc ...
-
Business Operations Specialist I/II
1 week ago
Emergent Holdings Lansing, United StatesJob DescriptionSUMMARY: Responsible for performing tasks for multiple divisional/regional directors, managers and supervisors which may be highly confidential and sensitive utilizing considerable independent judgment. Performs administrative work, including, organizing, schedulin ...
-
Internal Auditor I or II
1 week ago
Zobility Lansing, United StatesPosition Summary · Internal Auditor is responsible for the company internal control and audits to ensure the organization's operational efficiency, financial integrity, regulatory compliance, and information security. · This position works closely with the Company Headquarters i ...
-
Program Specialist I
1 week ago
Centene Corporation Lansing, United StatesYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ...
-
Talent Acquisition Specialist I
1 week ago
Jackson National Life Lansing, United StatesThe Talent Acquisition Specialist I is responsible for the recruitment and selection of top talent in order to meet Jackson's diverse hiring needs. Responsibilities include providing high-level client service to key stakeholders in an effort to ident Acquisition Specialist, Talen ...
-
Talent Acquisition Specialist I
1 week ago
Jackson Lansing, United States Full timeJob Purpose · The Talent Acquisition Specialist I is responsible for the recruitment and selection of top talent in order to meet Jackson's diverse hiring needs. Responsibilities include providing high-level client service to key stakeholders in an effort to identify, attract an ...
-
Internal Auditor I or II Bi-Lingual
1 week ago
DENSO TEN AMERICA Limited Lansing, United StatesJob Description · Job Description · Position Summary/Purpose · Internal Auditor is responsible for the company internal control and audits to ensure the organization's operational efficiency, financial integrity, regulatory compliance, and information security. This position wo ...
-
Technical Support Specialist II
5 days ago
MiHIN East Lansing, United States**Technical Support Specialist II** · Remote - East Lansing, MI **Position Purpose** · The Michigan Health Information Network Shared Services (MiHIN) is looking for a Technical Support Specialist to join our Application Support department. The Technical Support Specialist is a ...
-
Surgical Equipment Repair Specialist I
1 week ago
Agiliti Health, Inc. Lansing, United StatesJob Description: · Who We Are · At Agiliti, we believe every interaction has the power to change a life. We are a nationwide company of passionate medical equipment management experts who proudly serve hospitals and healthcare facilities to ensure quality medical equipment is i ...
-
php-customer serv specialist i
1 week ago
Sparrow Health System Lansing, United StatesJob ID:43092 · Positions Location: Lansing, MI · Job Description General Purpose of Job: · Description: · Positions Location: · Lansing, MI · Job Description · General Purpose of Job : · Responsible for supporting Customer Service goals and objectives by interacting direct ...
-
Youth Specialist II, Independent Living Plus
1 week ago
Samaritas Lansing, United StatesPosition Details · Do you have a passion for helping youth? We have a YOUTH SPECIALIST role in the Lansing area providing direct assistance and guidance to youth transitioning between foster care and independent living in Staff Supported Housing. We will train someone with a hear ...
-
Trinity Health Lansing, United StatesEmployment Type: · Full time · Shift: · Day Shift · Description: · Provides analysis, functional support and maintenance of enterprise, regional or local level clinical software applications for multiple clinical user clients at Regional Health Ministry (RHM) sites. Builds and ...
-
AmeriCorps Lansing, United StatesLansing MI- Food Access Specialist I Northwest Initiative · Roles and Responsibilities: Gardening · Independently maintaining the school/community gardens at Willow at Riddle School in Lansing, including, but not limited to: infrastructure repairs, tilling, mowing, weeding, wate ...
-
beBee Handyman Lansing, MI, United States FreelanceI am in need of a Psychologist service with the following characteristics in Lansing, MI:What does the patient feel? · Anxiety, anger, loneliness, sadness, depression, confusion · What type of specialist is needed? · I don't know · How old is the patient? · Adult · Is this servic ...
-
Systems Specialist II
5 days ago
Konica Minolta Business Solutions Ltd Lyons, United StatesJob Description · OverviewThe ideal candidate possesses an enthusiastic, and growth-oriented, personality capable of thriving in a fast-paced dynamic environment. Passionate about technology and providing outstanding experiences for our clients. We seek team members who are focu ...
-
Systems Specialist II
5 days ago
Konica Minolta Business Solutions Ltd Lyons, United StatesJob Description OverviewThe ideal candidate possesses an enthusiastic, and growth-oriented, personality capable of thriving in a fast-paced dynamic environment. Passionate about technology and providing outstanding experiences for our clients. We seek team members who are focused ...
-
Prior Authorization Specialist I
1 week ago
Memorial Healthcare Owosso, United StatesJOB SUMMARY # Under the guidance of the Manager of Patient Access and Director of Revenue Cycle, the Prior Approval Specialist will oversee the process of collecting all necessary documentation needed for approval of hospital diagnostic testing, outpatient procedures, surgery, in ...
-
Prior Authorization Specialist I
6 days ago
Memorial Healthcare Owosso, United StatesJOB SUMMARY # Under the guidance of the Manager of Patient Access and Director of Revenue Cycle, the Prior Approval Specialist will oversee the process of collecting all necessary documentation needed for approval of hospital diagnostic testing, outpatient procedures, surgery, in ...
-
Prior Authorization Specialist I
1 week ago
Memorial Healthcare Owosso, United StatesJOB SUMMARY # Under the guidance of the Manager of Patient Access and Director of Revenue Cycle, the Prior Approval Specialist will oversee the process of collecting all necessary documentation needed for approval of hospital diagnostic testing, outpatient procedures, surgery, in ...
-
beBee Handyman Okemos, MI, United States FreelanceI went to a psychotherapist who was unable to address my problems and situation. I have been experiencing extreme mood swings for years, but in the past few months they have reached extreme levels. I feel overwhelmed and I need help because I cannot handle this on my own. · What ...
Provider Relations Specialist I/II - Lansing, United States - Emergent Holdings
Description
Job DescriptionSUMMARY:
Provider Relations Specialist I
Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.
Provider Relations Specialist II
Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.
PRIMARY RESPONSIBILITIES:
PRIMARY RESPONSIBILITIES: Provider Relations Specialist I
EMPLOYMENT QUALIFICATIONS:
EDUCATION REQUIRED:
Provider Relations Specialists I
Provider Relations Specialists I
Provider Relations Specialists I
Work is performed in an office setting with no unusual hazards.
REQUIRED TESTING:
Proofreading, 10 Key, Math, Basic Windows, Reading Comprehension, Typing 40wpm, Intermediate Word, Intermediate Excel