Provider Services Specialist

Job Summary:

Rapidly growing healthcare technology company is looking for outgoing, energetic, and motivated individuals to join our Provider Services team. If you possess these qualities and want to be part of a passionate team on a mission to drive change in healthcare, then Green Light could be a great fit for you. Ideal candidates will share our core values, be a team player, possess a strong work ethic, be a problem solver, have professional integrity and a sense of humor!

Responsibilities:

• Engage with medical billing representatives on inbound telephonic inquiries relating to medical claim reimbursements and/or explanation of benefits. Facilitate the flow of information, as is necessary to fulfill information requests initiated by the provider’s billing representatives.
• Manage incoming appeals process on behalf of our customer health plans.
• Research appeals and related information to determine if additional consideration or reprocessing of claim is warranted or necessary, while ensuring overall compliance with health plan policies and guidelines.
• Manage appeals that fall under the No Surprises Act (“NSA”) to ensure proper handling throughout the settlement process within established timelines, which may include Open Negotiations and Independent Dispute Resolution (“IDR”) process.
• Facilitate the flow of information regarding medical claims appeals from healthcare providers to internal and client stakeholders.
• Communicate the pricing methodology, plan policies, and benefit determinations used by the health plan for establishing allowances on claims submitted for healthcare services.
• Initiate telephone communication with respect to appeals submitted to our customers health plans, mediate appeals, and apply effective telephone communication skills to provide required information or reach successful resolution.
• Generate Appeal Settlement Agreements based on written and verbal communication with the Provider throughout the appeals process.
• Manage ongoing communication with healthcare billing offices to ensure resolution of outstanding appeals.
• Collaborate, coordinate, and communicate across the organization, as necessary, to successfully manage and track status of ongoing Provider appeals.
• Work with internal and client stakeholders, to coordinate the necessary flow of information required to successfully obtain settlement of appeals.
• Ensure compliance with HIPAA protocol.

Qualifications:

• 3-5 years of Customer Service experience in healthcare, with working knowledge of Healthcare Billing/Coding process and terminology
• 1 year experience working within the requirements of the No Surprises Act.
• Requires a high school diploma or equivalent.
• Excellent oral and written skills and strong ability to multi-task.
• Ability to learn quickly.
• Knowledge of healthcare claims and reimbursement process
• Knowledge of commonly used medical terminology.
• Knowledge of HIPAA or appreciation of importance of IT security.
• Familiarity with healthcare coding is a plus.

Salary : $25 - $28