Provider Assistant Representative
CurrentKnowledge of health care claims operations, processes, and procedures to assist providers calling in for help with their claim issues. Answer, resolve, track and document telephone calls from providers in a timely and professional manner. Promptly review claim entries, issues and provide resolutions utilizing multiple system databases including TPL and Medicare priority levels to ensure proper payment.Interpret member(s) eligibility and coverage thorough knowledge of the contracts, policies and procedures and confirm coverage with providers.Identify trends/issues that emerge in calls/correspondence, and inform the Team Lead or Supervisor. Demonstrate and maintain a thorough and complete working knowledge of appropriate UCare information management systems and the CADI phone system.Maintain good working relationships and open communication with internal and external customers.