Job Information
Blue Cross and Blue Shield of Louisiana Provider Disputes Support Specialist in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
Grade 05
POSITION PURPOSE
Coordinates the review of all cases by recording and assigning all provider disputes. Prioritizes, organizes, distributes, and tracks incoming mail/case material. Records the flow of information and assigns it to the appropriate person/queues. Performs administrative and clerical support to PDRA.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: SUPERVISOR, PROVIDER DISPUTES
Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with various internal and external entities including but not limited to, Member Services, Provider Services, Correspondence, Legal and Utilization Management, as well as members, hospitals and physician offices.
QUALIFICATIONS
Education
- High School Diploma or equivalent is required.
Work Experience
2 years of general medical/insurance office experience with either claims processing knowledge or provider/member servicing is required.
Must have experience using Microsoft Office applications, including Word, Excel and PowerPoint.
Facets experience is preferred.
Skills and Abilities
Licenses and Certifications
- None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Assist Manager and Supervisor with clerical/administrative tasks relating to the intake and reporting of all Department incoming cases. Assists with distribution of correspondence and internal referrals; and follow up with Department staff and internal departments as directed by management to ensure claims processing and benefit payments are completed consistent with information relayed to providers and within timeframes required by law, regulation, policy or other requirement.
Forwards Medical Appeals, FEP appeals, and Correspondence to the appropriate departments in a timely manner.
Assigns tasks to Provider Disputes Specialist based on review and research of the incoming provider disputes.
Assists with preparing materials for appeal reviews (copying, creation of case binders, coordinate mailing or electronic communications, etc.) and distributing dispute cases and related information to reviewers. This includes ensuring all materials meet minimum necessary rule requirements consistent with internal policies and state/federal privacy laws.
Assists with creating and maintaining electronic files and hard copy paper files; maintains and tracks department cases and files; assists with preparing and issuing reports required for various internal committee meetings and as needed on an ad hoc basis. Assists with updating database for all dispute cases.
Assists with maintaining inventory of office supplies, maintain file of receipts and follows-up on outstanding orders.
Navigates in Facets and Jiva systems to assess claims and authorizations for provider disputes, member appeals and medical appeals. Performs other duties as assigned.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
#LI_SH1
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance