This job is posted for Omaha, NE.
General Summary:
The Operations Specialist provides day-to-day support for operations. Assists providers and payers in registration, authorization, and administration of the Midlands Choice secure website. Assists with providing in-depth professional, courteous, efficient, timely and accurate resolution to customer inquiries. Develops and maintains positive customer relationships and serves as the customer advocate to the company. Provides timely and accurate support to provider outreach projects, claim entry and processing, mail processing, and fee schedule requests.
Essential Job Functions:
1. Researches and manages all provider and payer requests for access to Midlands Choice website. Responsible for approving or denying requests based upon guidelines built for the process. Processes web account audits in accordance with compliance requirements.
2. Sorts incoming mail and prepares outgoing mail.
3. Enters, reworks and corrects claims in the repricing system using additional systems and tools as needed.
4. Responds to provider fee schedules, rate appendices, and modifier guideline requests timely.
5. Provides outreach to providers regarding demographic issues and claims trends or assists other departments with similar outreach for projects.
6. Enhances customer satisfaction and retention through knowledgeable and professional interaction with customers that instills confidence in Midlands Choice, its products, and its services. Accesses information from a variety of systems and references to provide complete and accurate resolution to customer inquiries.
7. Provides centralized customer service through both inbound and outbound interactions, which involves answering queries and resolving timely issues for members, payers, and providers through understanding of their questions, anticipating their needs, and providing solutions.
8. Provides phone backup to customer service representatives.
9. Accurately completes documentation of all incoming calls or cases received. Identifies the nature of each call and captures the details of the information communicated to the customer to accomplish this.
10. Provides timely service to payer and provider clients by meeting their day-to-day business needs.
11. Provides information about on-going customer concerns or trends to management, which includes, but is not limited to, suggestions for improvements regarding service issues and procedures.
12. Maintains a high level of integrity and discretion during interaction with team members.
13. Consistently maintains all established service expectations and goals for the department including, but not limited to, phone quality, stats, and timeliness standards. Participates in performance improvements.
Knowledge, Skills, and Abilities:
1. Knowledge of managed healthcare systems and health insurance industry.
2. Knowledge of HIPAA privacy and security protocols.
3. Customer focused with the ability to proactively develop customer relationships by listening, understanding, anticipating, and providing solutions to customer needs.
4. Ability to problem solve using analytical and independent thinking.
5. Ability to use good judgment and sound decision-making based on relevant information and deductive reasoning.
6. Ability to resolve issues and conflicts while maintaining composure and confidence.
7. Ability to adapt to change and work as a team member.
8. Desire for continuous learning and skills improvement.
9. Ability to communicate with supervisors, co-workers, customers, and various business contacts in an effective, professional, courteous, and congenial manner.
10. Ability to prioritize work and handle multiple tasks/assignments.
Education and Experience:
1. High school diploma or equivalent.
2. At least two years of successful experience in a customer service/claims environment required in managed healthcare.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- On-the-job training
- Paid time off
- Prescription drug insurance
- Professional development assistance
- Tuition reimbursement
- Vision insurance
Work Location: Hybrid remote in Omaha, NE 68154
