Program Support Representative III/Medical Biller

Description:

• Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected. • Exceptional organizational skills are required • To a lesser degree, the resource may provide initial support for customer requests via telephone, email, fax, or other available means of contact to the Support Center. • Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary. • Works under moderate supervision and typically reports to the Customer Service Supervisor.

Skills:

insurance verification, prior authorization, medical insurance, Case Management, Medical Billing, Claim, Data entry, Customer support, Medicare, Call center, Pharmacy, Customer service, Health care, Support, Insurance

Top Skills Details:

insurance verification,prior authorization,medical insurance,Case Management,Medical Billing,Claim,Data entry,Customer support,Medicare

Additional Skills & Qualifications:

• HIPPA certified • Experience in claim processing required • Medical Billing and Coding Certification required • Ability to interpret Explanation of Benefits (EOB) • Customer Service Experience preferred. • Pharmacy Technician experience preferred. - Must have experience with UB04/CMS1500 (Claims Forms) - EOP/EOB Literacy as well as 837/EDI knowledge

Experience Level:

Expert Level