Bill Review Services Associate III

Job Description

About Conduent

Conduent delivers mission-critical services and solutions on behalf of businesses and governments creating exceptional outcomes for its clients and the millions of people who count on them. Through people, process and technology, Conduent solutions and services automate workflows, improve efficiencies, reduce costs and enable revenue growth. It’s why most Fortune 100 companies and over 500 government entities depend on Conduent every day to manage their essential interactions and move their operations forward.

 

Conduent’s differentiated services and solutions improve experiences for millions of people every day, including two-thirds of all insured patients in the U.S., 10 million employees who use its HR Services, and nearly nine million people who travel through toll systems daily. Conduent’s solutions deliver exceptional outcomes for its clients including $16 billion in medical bill savings, up to 40% efficiency increase in HR operations, and up to 40% improvement in processing costs, while driving higher end-user satisfaction. Learn more at www.conduent.com.


Job Description

Job Summary

 

The Provider Relations Representative, Floor Support is responsible for answering phone inquiries pertaining to workers compensation claims from multi-state medical providers. In addition, this Representative should work a shift opposite their supervisor, and provide floor support for the team, which can include, but not limited to, team questions, escalated calls, and any other issues that arise. Level 3 agents should be able to cover day to day operational activities if the supervisor is out for a meeting or on PTO. An understanding of company computer systems, StrataWare, CompIQ and Call Track, is required to answer, return and manage calls. The primary function of the Provider Relations Representative is to provide prompt, courteous and professional Customer Service at all times.

 

 

Minimum Qualifications

 

  1. High school diploma/GED
  2. Ability to learn ICD-9/ICD-10 and CPT/HCOC coding
  3. Ability to use Microsoft Windows-based software
  4. Ability to learn and apply basic medical terminology
  5. Excellent oral and written skills in English (American)
  6. Ability to assess and document reconsideration issues based on caller’s issue
  7. Ability to work in a team environment
  8. Minimum one (1) year of Customer Service experience (voice)
  9. Must be able to work an 8 hour shift between 8am EST and 8pm EST, Monday Through Friday, in addition to working on holidays in the Philippines and having no work on U.S. holidays.

 

Preferred Qualifications

 

  1. Two (2) years experience in Customer Service Department
  2. Two (2) years experience in Workers’ Compensation
  3. Two (2) years experience in a medical setting
  4. Six (6) months experience in Bill Review Department

Primary Responsibilities

          

  1. Assist the team with questions, escalated calls, and floor support, report and operating under the direction of the Supervisor.
  2. Provide prompt, courteous and accurate customer service for all calls, with a solid understanding of worker’s compensation guidelines.
  3. Working knowledge of StrataWare/CompIQ, Call Track, and any client proprietary software
  4. Understanding of State rulings and regulations as relating to Workers’ Compensation.
  5. Understanding of medical bill processing rules and guidelines, including how to read Bill Review Logs.
  6. Perform administrative tasks such as managing faxes, resubmitting bills, updating spreadsheets, phone message retrieval, and e-mails within 24 hours, etc.
  7. Processing medical bills, coding, or data entry with 98% accuracy during phone downtime or as assigned.
  8. Be available to switch schedules, with little notice, between the hours of 8am and 8pm, Monday through Friday, to provide support coverage for our call centers.

Collateral Responsibilities

 

  1. Demonstrate the ability to work both individually and in a team environment
  2. Respond to provider issues and direct problem resolution
  3. Set an example of courtesy and professionalism for all co-workers and customers
  4. Complete additional work assignments as required by management

 

Performance Expectations

 

  1. Demonstrate the ability to use Stratraware/CompIQ and any client proprietary software to locate claim information (by social security number, claim number or patient name) to provide current status (check information, authorization and/or compensability).
  2. Analyze Call Track data to determine that the information gathered is correct and calls can be resolved.
  3. Meet the daily quota for data entry and bill processing during downtime, or as assigned.
  4. Maintain a schedule adherence rating of less than 5 minutes per work day.
  5. Maintain a quality level of 94% or higher on a monthly basis.
  6. Maintain a monthly review score of 3 or higher (on a 1-4 scale) each month.
  7. Live and recorded calls will be monitored by supervisors and played to the entire team, for the purpose of training & development, as well as in new hire sessions.
  8. Demonstrate an understanding of the Bill Review guidelines and procedures.
  9. Demonstrate professional attitude and communication at all times with coworkers.
  10. Adhere to the Conduent’s attendance policy.

 

Physical Demands and Work Environment

 

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Physical demands: prolonged sitting; use hands to finger or handle objects or controls; occasionally reach with hands and arms; occasionally lift and/or move up to 15 pounds; frequent talking; hear; prolonged viewing of computer monitor.

Work environment: indoor office environment; minimal noise level.


Closing

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form.