Summary
Provides technical oversight to Health and Business staff on correspondence and contracts, responding to questions, complex service issues, demographic data and workflow issues. Assists department with special projects, implementation and execution of new programs and processes. Analyzes department production reports, turnaround time and various department data.
Duties
- Serve as the main point of contact for healthcare providers, addressing inquiries and concerns promptly.
- Resolve provider-related issues and disputes efficiently.
- Provide support to providers on policies, procedures, and issue resolution practices.
- Complete telephone records supplying all information necessary to resolve providers concerns.
- Actively engages in communication and response with internal and external customers.
- Maintain production and quality to ensure that department standards and goals are being met.
- Research network service issues.
- Coordinate with the Contract Admin and supervisor to determine appropriate action needed for resolution or resolves issues.
- Analyze and investigate all issue categories including quality assurance issues and coordinates with appropriate parties to resolve issue.
- Work with Contract Admin or Supervisor to implement workflows related to implementation activities.
- Create and make changes as needed to network management desk level procedures.
- Identify issue trends to assist with workflow updates or changes as needed. Assists with job aides and Desk Level procedures.
- Assist with projects resulting from network pricing adjustments. This includes determining appropriate workflow, resources needed and coordinating with internal departments to insure minimal impact to payers or clients.
- Work with Quality Assurance Specialist to review audit results and appeal when issues are identified.
- Address daily reports received from internal areas and plan inquiries.
- Other duties as assigned.
Education Requirements
Requires two years of college (60 credit hours), additional years of qualifying experience may be considered in lieu of education.
Experience Requirements
- Requires three years health or dental-care, insurance administration experience or similar.
- Requires three years health or dental-care, insurance administration experience or similar.
- Requires effective verbal and written communication skills to respond to members, providers, network vendors, internal contacts and GEHA Management.
- Requires knowledge of MS Excel and Access.
- Requires analytic skills to evaluate network, provider and member data.
- Candidates must reside in KC metro area.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
