Service Advocate – Claims III

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The Medical Records Unit is responsible for providing excellent support service in requesting and transmitting medical records supporting accurate and timely adjudication of claims for Blue Card Host, Home and Local areas within the Service Organization. Provider Service Advocate directly contributes to provider experience, satisfaction, and reputation management of the unit and organization.

The Medical Record Service Advocate is expected to:

• Review all requests for medical records from Blue Card Host, Home and Local Plans
• Understand Blue Cross Blue Shield Association Guidelines pertaining to requesting and transmitting medical records
• Interpret, research, analyze, document and respond timely to all medical record requests and forward accordingly
• Perform analysis to determine root cause of issues and escalate to leadership as appropriate.
• Review and complete all related training CBTs updates or changes
• Review and respond to all email communications timely
• Attend and participate in all TWC Meetings
• Perform other duties as assigned

Requirements:

• High School diploma or equivalent
• 2+ years related work experience or equivalent combination of transferable experience and education
• Excellent communication skills
• Proven organizational skills with strong attention to detail
• Ability to work independently, collaboratively, and use appropriate judgment to make independent decisions by following general guidelines.
• Ability to work in fast paced environment, to be self-motivated, results driven, and can multi-task priorities
• Good attendance
• Knowledge level Microsoft Office

Required Competencies:

• Teamwork and collaboration
• Customer focus
• Driving for results
• Continuous improvement
• Displaying technical expertise

Preferred skills:

• Experience with Diamond, Siebel, Quest, CMCA, JIVA, Blue
  2
  and PIMS
• Experience with Continuous Improvement Methodologies and tools
• Knowledge and understanding of the health insurance industry, plans, terminology, benefits, and claims processing in multiple lines of business
• Knowledge of healthcare delivery system, provider types, provider contracting and networks, medial review tips and medical coverage guidelines (MCG)