Customer Service Support Team Specialist, Geisinger Health Plan (Work from Home Pennsylvania Resident)
Location: Danville, Pennsylvania
Type: Full Time
Internal Number: R-23593
Assists Customer Service Support Team (CSST) Leader by providing direct back up support to the Customer Service Support Team in the areas of Benefits, Provider File Maintenance, Enrollment, claims processing, Coordination of Benefits and Subrogation by actively participating in cross training, improving processes within the team and contributing in staff meetings.Primary job duties will encompass referral entry and management process.
Assists Benefit System Coordinator in the design, testing and implementation of system benefits and configuration.
Assists staff with system benefit issues.
Acts as direct back up to support for Benefits Specialist.
Processes claim reports and reviews for completeness and eligibility.
Determines that the services received are covered benefits according to processing guidelines.
Determines appropriate payment or rejection as per provider contract.
Reviews problem claims and medical records and defers any medical judgment decisions to appropriate department and staff.
Reviews identified claims and determines primary and secondary payor responsibilities, recognizing appropriate guidelines as proposed by the National Association of Insurance Commissioners (NAIC).
Communicates) with members and providers to identify other applicable insurers and to determine primary payor responsibility.
Communicates with members, providers and Legal Department to identify cases in which Subrogation applies.
Answers incoming calls from members and providers with COB and Subrogation questions and concerns.
Investigates and communicates resolution of inquiries.
Assists Team Leader in the design, testing and implementation of Third Party Recovery Liability system configuration.
Assists in initiating proper financial terms and accurate set up of contractual arrangements is provider module.
Maintains documentation of provider set up and pricing information in provider module.
Processes retroactive enrollment adjustments at the request of the Customer Service Teams.
Receives written notification from Accounts Receivable department and accurately processes group terminations.
Reviews and accurately processes group renewal information and miscellaneous group data updates.
Produces and distributes group information documents (i.e. monthly enrollment statistics, code listings, etc.) as required.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
High School Diploma or Equivalent (GED)- (Required)
Minimum of 2 years-Healthcare (Required), Minimum of 2 years-Health Insurance/Managed Care (Preferred)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13... hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.