Job Description

In this role you will be responsible for:

• Communicate with contracted and non-contracted Providers by providing information and assistance as appropriate.
• Assist Providers with interpreting Member eligibility and benefit information
• Assist with general question about the existing Programs and Member benefits.
• Assist with direction on the available Provider portal, including how to set up accounts, troubleshooting and navigating the website, how to submit and retrieve necessary information.
• Handle claim status inquiries, researching and facilitating resolution of payment issues; provider education on remittance advice interpretation and reimbursement, and informing providers of the claims appeals process.
• Work closely with the Claims Team in resolving claims discrepancies, inappropriate denials and delays in payments.
• Provide providers with eligibility; process authorizations and Exception Requests
• Answer questions regarding authorizations and denials
• Meet NTT Call Center Standard Work and performance expectations. This includes, but is not limited to the following:
  • Successful completion of Provider Call Center training
  • Active participation in continuous training
  • Follow required call scripts and QA requirements.
  • Ability to handle high call volume.
• Provide excellent customer service to all callers. Demonstrate a high level of patience and respect with every caller, ensuring each caller is assisted promptly and appropriately and follow Provider Call Center established call handle Quality Assurance Standards and Objectives.
• Assist the Provider Call Center or Provider Services Departments with projects, as needed.
• Timely follow up with Providers on cases as needed.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined policies and procedures relating to HIPAA compliance.

Qualification Required

• High School Graduate