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Advocate Health Care’s energetic and supportive work culture will allow you to push your skills and career farther than you’d expect. From continuing education and training to work/life balances that ensure you stay close to what’s important to you, Advocate is ready to help you reach the next level.

Job Description

Cust Provider Resolution Rep
Date: 09/29/2009
Location: Mount Prospect, IL
Facility:HEALTH PARTNERS OPERATIONS
Cust Provider Resolution Rep - 28003 		Apply Now
• Excellent communication skills.
• Ability to work independently.
• Knowledge of PC, windows, database environment.
• Excellent problem solving skills.
• Ability to read and interpret standard contract language and effectively communicate back to providers.
• Ability to assess situations to optimize call center performance.
• 1-3 years experience with MS Office
• 4-5 years of managed care or insurance experience.
• Experience with difficult, irate calls.
• 2-4 years adjudication claims issues.
• College degree or equivalent experience
• Demonstrated ability to excel in this role, well beyond standard expectations.
• Medical terminology.
• Knowledge of various reimbursement methodologies for both physicians and hospitals.
• Ability to succeed in multifaceted, fast paced, changing environment.

Job Description:

Full Time Customer Service 8:30 AM to 5 PM

LOCATION:
1661 Feehanville Drive - Suite 200
Mt. Prospect, Illinois 60056 - 0222

Resolves a variety of difficult issues. De-escalate irate calls and provide efficient, effective quality service to members, physicians, vendors, employer groups, managed care organizations and contracted Physician Hospital Organizations and Advocate Health Centers. Addresses previously processed claims and reprocesses as needed. Educates providers, billing personnel, members and MCO representatives regarding plan provisions, risk issues, billing processes and errors, contract terms, eligibility issues and referral guidelines. Resolves internal and external issues for the caller.
Accountabilities:
1. Eligibility, Benefits and General Duties
2. Provide Education and Assistance
3. Claims and Referral Issues
4. Contract and MCO Contract Interpretation
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