Claims & Provider Relations Advocate - Evernorth Behavioral ...

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Requirements:

• Bachelor's degree in the mental health field or psychology/social work-related field (family communications, health coaching, community/public health or other related major), or a bachelor’s degree in an unrelated field and 2-3 years of experience in the behavioral health field.
• Customer Service experience
• Experience in the Evernorth Behavioral Care Specialist/Advocacy role
• Able to excel and/or prior successful experience in a virtual team environment
• Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.
• Candidate must possess superb interpersonal communication skills
• Effective listening and organizational skills, with the ability to manage multiple tasks
• Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications
• Independent problem solving skills
• Strong time management skills
• Ability to type effectively and have strong PC skills
• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Responsibilities:

• Assist a member or provider with understanding how a claim has processed
• Verify claim status for a member or provider
• Educate a member or provider on billing protocols
• Write or correct authorizations to ensure claims are paid correctly
• Send claims for adjustment/reprocessing
• Request duplicate EOBs for a member or provider
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check
• Provide follow-up on issues by making outbound calls when necessary
• Send resources to members and providers via email
• Submit a complaint on the member or provider’s behalf
• Send an Advocate Handoff/Help Request (AHHR) for escalated or complex issues
• Assist providers with contract related inquiries and demographic updates
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved