The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.
These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
In this position, you will handle all provider file update requests, received from participating providers, in accordance with the established timeline while developing and maintaining positive provider / customer services.
You will be asked to coordinate with various Elderplan departments and NPO teams to ensure provider file update requests and demographic-related claim denial inquiries are handled appropriately while balancing provider needs with Plan priorities.
In addition, you will handle and organize correspondence from non-par providers, under the file update process, for the Data Maintenance Team, as needed.
Communicate the receipt / completion of all file update correspondence received from provider / designee in a timely and consistent manner.
Other duties will involve educating participating providers regarding any updates to the processes and escalating any issues to the Provider Relations / IPA, among other teams.
- High School diploma
- Bachelor's degree preferred
- With Bachelor's degree; minimum of one year of experience in Managed Care, provider billing, and / or customer service.
- Without Bachelor's degree, minimum of three (3) years of experience, as above
- Knowledge of Microsoft Office
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