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Operations Account Rep (Claims) - Phoenix

Posted on Jun 14, 2019 by Wellcare

Phoenix, AZ 85016
Immediate Start
Annual Salary

Serves as an account representative with facility (institutional) and provider groups maximizing their ability to interact with WellCare. Manages education and issues related to claims, reimbursement, authorizations and referrals. Responsible for onsite interaction as necessary with high maintenance providers/strategic providers.

Department: Ops-Claims I

Reports to: Mgr. / Dir. Operations Acct Mgmt.

Location: E. Camelback Road

Essential Functions:

  • Educates providers on common billing practice errors and reimbursement policies.
  • Educates and drives adoption of self service tools (EDI, Provider Portal, EMR, etc.).
  • Conducts root cause analysis on claims adjudication or related issues via direct access to applicable tools
  • Educate providers on service model to drive adoption and be the conduit to assist when service fails.
  • Drives providers to the standard process; supplements and supports as necessary.
  • Partners internally with information exchange when WellCare has failed on service.
  • Conduit for provider issues that cross multiple platforms and/or result from integrations.
  • Obtains signed documentation via face to face provider visit when necessary in support of recontracting lead by Network Development and recredentialing lead by Credentialling Dept. Scans and submits collected information in timely manner.
Additional Responsibilities:

    Candidate Education:

    • Required A High School or GED
    • Preferred A Bachelor's Degree in a related field Bachelor's degree may be substituted for up to 2 years of required experience
    Candidate Experience:
    • Required 3 years of experience in Customer Service/relationship building position that involved problem solving and critical thinking skills
    • Preferred 1 year of experience in Physician/Hospital Billing Manager or Medical Practice Administrator strongly preferred.
    • Preferred Other Experience in a professional level audit and recovery operations position with experience working with claims data and inaccurate payments
    Candidate Skills:
    • Intermediate Other Basic knowledge of CPT and ICD-9/10 coding.
    • Intermediate Other Strong relationship building skills and highly developed customer focus skills.
    • Advanced Other Comprehensive knowledge of how a claim is built and paid.
    • Advanced Other Understanding of practice management operations.
    • Advanced Other Strong analytics or root-cause analysis experience.
    • Advanced Other Highly developed presentation skills.
    • Advanced Other Strong self-management skills, ability to handle rapid change and an affinity for continuous learning.
    • Advanced Other Detailed knowledge about health plan operations.
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Certified Coding Associate (CCA) CMPE (Certification of Medical Practice Executive)
    • Preferred Certified Coding Specialist - Physician Based (CCS-P)
    • Preferred Certified Coding Specialist (CCS)
    Technical Skills:
    • Required Advanced Microsoft Word
    • Required Advanced Microsoft PowerPoint
    • Required Advanced Microsoft Excel

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

      Reference: 720881919