Bill Review Provider Relations Specialist I

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The Provider Relations Representative is responsible for answering phone inquiries pertaining to workers compensation claims from multi-state medical providers. An understanding of company computer systems, CompIQ, StrataWare and/or Call Track, is required to answer, return and manage calls in keeping with medical bill review. The primary function of the Provider Relations Representative is to provide prompt, courteous and professional customer service, resolving issues centered in work comp.

* Primary Responsibilities * Working knowledge of Strataware/CompIQ, and/or Call Track * Understanding of State rulings and regulations as relating to Workers' Compensation * Understanding of medical bill processing rules and guidelines * Provide prompt, courteous and accurate customer service * Perform administrative tasks such as managing faxes and phone message retrieval within 24 hours * Facilitate the processing of ""PRIORITY"" request to ensure that bill review processors make the necessary changes with 48 hours * Collateral Responsibilities * Demonstrate the ability to work both individually and in a team environment * Respond to provider issues and direct problem resolution * Set an example of courtesy and professionalism for all co-workers and customers * Complete additional work assignments as required by management * Performance Expectations * Demonstrate the ability to use Stratraware/CompIQ and Citadel to locate claim information (by social security number, claim number or patient name) to provide current status (check information, authorization and/or compensability). * Analyze Call Track data to determine that the information gathered is correct and calls can be resolved. * Maintain a schedule adherence rating of 95% or higher. * Maintain a quality level of 3.0 or higher (scale 1-5). * Demonstrate an understanding of the Bill Review guidelines and procedures. * Demonstrate professional attitude and communication at all times with coworkers * Adhere to the Bill Review Department Dependability guidelines.

* Minimum Qualifications * High school diploma/GED * Ability to learn ICD-9/10 and CPT coding * Ability to use Microsoft Windows-based software * Ability to learn and apply basic medical terminology * Good oral and written skills * Ability to assess and document reconsideration issues * Ability to work in a team environment * Minimum one (1) year of Customer Service experience or six months of Medical Bill Review processing. * Preferred Qualifications * Two (2) years experience in Customer Service Department * Two (2) years experience in Workers' Compensation * Two (2) years experience in a medical setting * Six (6) months experience in Bill Review Department