Claims Customer Experience Coordinator (REMOTE) SWHR CNC

Support Services
21003290 Requisition #
212 Total Views
Southwestern Health Resources (SWHR CIN) seeks to hire a Claims Customer Experience Coordinator to work Full Time supporting the Care N’ Care department.
Please note: Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern.  If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.
This position is a Remote/Work from Home opportunity 
Salary range is Min $15.19 - Max $22.48 – based on relevant experience
Work Schedule
Monday – Friday, 8:00am-5:00pm
Job Description
Provide exceptional service across entire health plan customer base via telephonic, electronically or in person methods as applicable. Serve health plan member population, prospective members, sales agents and healthcare providers with issues including but not limited to benefits and eligibility validation, claims status and complex claims routing, billing, enrollment, provider search, PCP assignment and appointment setting, provider portal questions, benefit education, appointments and RSVP processing, assist with incoming enrollment facilitation, may assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider dispute, appeals and grievance and other inquiries as presented.

Receive, intake and process and send written acknowledgement of resolution or dismissal on all in-network provider dispute correspondence that enters the facility via mail or fax, clearly and timely documenting all interactions as applicable.

Intake and process and triage all claims refund checks, W9, medical records and other applicable claims correspondence that enters the Care N’ Care facility via mail to appropriate departments or functional areas.

Facilitate W9 process for out-of-network providers and/ or facilities as applicable and partner closely with claims vendor, consistently ensuring smooth exchange of claims correspondence.

Identify proper protocol routing, triage and escalation as necessary as well as full accountability of follow through and close out, including clear and relative documentation of standard and escalated issues at all times. Maintain personal metrics to established performance levels of the individual and team. Responsibilities may vary depending on seasonal business needs.
The ideal candidate will possess the following qualifications:
High School Diploma or equivalent Required

1 year basic knowledge CMS Guidelines, Medical Terminology and Coding Guidelines, QNXT and Facets system experience Required
Customer Service experience Strongly Preferred

Excellent problem solving and organizational skills while multitasking, as well as technical skills while navigating multiple platforms
Strong and grammatically correct written, verbal and in-person communication skills with excellent knowledge of the Microsoft suite of products
Ability to work independently and as a team member serving out customer base or on special projects as assigned

Individual Contributor

ADA Requirements
Working Indoors 67% or more

Physical Demands

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