If you are looking for an excellent career then look check this new position offered by the Anthem. New Network Services Specialist- HealthSun-Coconut Grove, Fl-PS33720 jobs are open in Coconut Grove, FL 33133. Apply before the application deadline.
Job: Network Services Specialist- HealthSun-Coconut Grove, Fl-PS33720
Location: Coconut Grove, FL 33133
SHIFT: Day Job
Your Talent. Our Vision. At HealthSun, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.
Network Services Specialist
Reviews incoming contracts and works with the Provider Relations Reps, IPA contacts and credentialing department to facilitate new and recontracting efforts for AH, HMO and PPO products. Works with hospital bill managers in resolving issues relating to hospitals in the health service area.
Primary duties may include, but are not limited to:
Researches pended claims and identify the problems and correct either internally or via provider education.
Assists in auditing provider database to ensure integrity of provider data. Monitors and resolves CSS issues with members.
Reviews professional claims to determine correct reimbursements (pre and post processing) to support network contract agreements.
Interacts with all applicable internal departments and physician reviewers, keeping abreast of health care trends, HCFA changes and supporting provider education relating to reimbursement and appropriate coding.
Requires a High School diploma or GED;
Or any combination of education and experience, which would provide an equivalent background.
Some secondary education preferred.
For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Customer service or call-center environment experience in a Healthcare Insurance industry preferred.
Working knowledge with Medicare Advantage plan strongly preferred.
Claims experience strongly preferred.
Medical terminology knowledge preferred
Bilingual (Spanish/English) preferred
Position is in a call center setting.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.