Resolve billing issuesAssist customers remotely via telephone with account issues and Prescription Orders while maintaining a positive attitude.Fax Dr office for request for new prescriptionsDocumentation of call issues and resolution. Maintain up-to-date on current and changing product policies, ensuring to provide customers with accurate information.White glove First Call ResolutionRecords details of inquiries, comments or complaints, transactions or interactions and takes action in accordance to it. Escalates unresolved and pending customer grievances. performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.

Responsibilities include but not limited to: Effective time management, organizational skills, medical billing and coding, data entry, extensive payer research, payer tracking(Medicare,Medicaid, Tricare, And Various Private Payers)benefit verifications, ensuring maximum reimbursement and follow-up for the providerObtain accurate benefits in order to qualify patients for co-pay or patient assistance programs offered by the manufacturerPrior authorization and Predetermination initiation processes in regards to medical procedures.Assisting Site Coordinators with accurate benefit informationPayer processes and Payer research to ensure timely processing of enrollments Credential as a Intake Specialist for Enrollment in Copay Referral Plan

Verified insurance benefits for existing members and handled prior-authorizations.Provide Status of Claims and Authorizations to ProvidersVerify CPT codes for Providers to know if they need Prior AuthorizationAnalyze claims to ensure if they were processed correctly at contractual rates.Provide Status of Claims and Authorizations to Providers.Record complaints, grievances and appeals.Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility and researching provider information.

Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims. Analyzes problems and provides information/solutions.Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database.Record complaints, grievances and appeals.Assist Clinical Case Managers to complete claims investigations and facilities claims payment by verifying authorizations, verifying member eligibility and researching provider information.Verified insurance benefits for existing members and handled prior-authorizations. Provide Status of Claims and Authorizations to ProvidersVerify CPT codes for Providers to know if they need Prior Authorization

Verified insurance benefits for existing members and handled prior-authorizations. Responded to inquiries regarding eligibility of benefits and coverage. Viewed and informed if members met their deductible and max-out-pocket expenses.Assisted member's concerning billing questions and process premiums payments. Answered questions pertaining to Medical Claims. Assisted with escalated calls regarding members loss of Advance premium tax credit from Health Marketplace. Changed PCP and issued out ID cards. Received inbound calls from beneficiaries enrolled into the Medicare Part D program. Assisted beneficiaries with updating account information, providing plan information, and resolving issues with utilization of the plan. Updated account information such as billing options and change of address or phone numbers. Researched premium billing discrepancies and prescription claims processed. Educated beneficiaries on how the Medicare Part D plan work, including benefits, cost sharing, and levels of coverage. Submitted mail request for beneficiaries such as ID cards and formularies. Looked up medicines on the formulary to verify if they were covered, the tier and copay level, and if a drug was not covered provides an explanation as to why. Assisted pharmacies with prescription denials and errors and verifying benefits. Advised providers on how to get prior authorization on medication prescribe with restrictions such as step therapy and quantity limits. Answered questions pertaining to mailings sent out by the company periodically.