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TriWest Healthcare Alliance Healthcare Claims Customer Service Representative in Phoenix, Arizona

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Job Summary

Handles inbound phone calls from Veterans, VA and other customers. Performs claims research and resolution regarding both institutional and professional claims. Reviews claims and responds to Veteran questions regarding billing issues. Works in a detailed, fast-paced, and repetitive production environment. Interacts with customers in a professional, formal manner where the focus is on completing the task pleasantly and with high quality and accuracy.

Key Responsibilities

o Utilizes various software applications in use at TriWest.o Understands procedures and processes of the VA program.o Performs claims research, including interpreting VA policies, investigating automated transactions, documenting outcomes, updating records and reporting accurately on research findings.o Resolves incorrect claims processing, calls providers for Missing claims and medical documentation to resolve Veteran billing issues. o Reviews authorizations to establish ancillary providers associated and obtain claims missing for payment.o Answers inbound calls from Veterans and providers in a timely manner. o Makes outbound calls to resolve Veteran billing issues.o Consistently displays professional and courteous service skills to internal and external customers.o Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes providing details about referrals, authorizations, claim status and billing discrepancies.o Protects the privacy of health information of patients when using or disclosing Protected Health Information ( PHI ). PHI is any information about health status, or healthcare services that is linked to an individual.

o Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries’ health information.o Documents all communications involving Veteran and provider contacts.o Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments. o Understands and utilizes the grievances and appeals process available to dissatisfied beneficiaries and providers.o Consistently meets department productivity and performance metrics.o Performs other duties as assigned.o Regular and reliable attendance is required.

Working Conditions

Ability to cover any work shift Monday – Friday and Sunday, with no travel o Ability to work overtime, if neededo Works within a standard office environmento Extensive computer work with prolonged sitting and wearing of headset o A VA-approved security clearance may be required

Education & Experience

Requir ed

o High School diploma or G.E.D.o 2+ years’ healthcare claims, billing or related claims areao Good communication skillso Call center or customer Service experienceo Knowledge of medical terminologyo Proficient with Outlook, Microsoft Excel, the Internet and on-line systems


o 1+ years college or equivalent experienceo 1 year call center or customer service experienceo Knowledge of medical claims processing/reviewo Managed Care experience