Provider Field Representative

Job description

·  Job Description:

·  Assisting providers with investigation of problematic claims
·  Monitoring and keeping abreast of billing manual changes as it relates to claims processing, etc. and their impact on the provider community
·  Interacting with DCH employees to resolve complex issues/topics that cannot be resolved in-house.
·  Monitoring and utilizing GAMMIS and related documentation to resolve claims processing issues within your assigned territory
·  On-site training seminars and workshops, as required
·  Completing six provider visits and three drop-ins per week .
·  Assisting with special projects as assigned by Supervisor (i.e. Call Center support)
·  Conduct monthly workshops in your assigned terrirtory
·  Resolving and following-up on all open CTNs within 72 business hours of CTMS assignment
·  Reviewing and resolving special processing of claims (Special Batching).
·  Completing a weekly status report

Education and Experience Required:

Bachelor's Degree (4 years) or equivalent Healthcare experience and one (1) year experience in the health care billing or healthcare public relations field (5 years total).

Knowledge and Skills:

·  At least 2 years of Medicaid claims/policies and procedures knowledge preferred
·  Experience resolving and following up on claims
·  Strong Customer Service skills
·  Strong Presentation skills
·  Ability to work independently while traveling