MOOP(MEMBER OUT OF POCKET)CUSTOMER SERVICE SPECIALIST (2 POSITIONS)- POSITION #2019-118
- Date Posted:
- Close Date:
- Full Time
- Redlands Monday - Friday 8:00a.m. - 5:00p.m.
The MOOP Customer
Services Representative serves as a point of contact for all Managed Care
Health Plans, Members and Providers. They will be responsible for resolving
complaints and inquiries regarding authorization, billings and claims, as well
as the Member Out of Pocket (MOOP). They will be required to run reports,
researching member’s accounts using the Practice Management System and EZ cap,
send notifications to internal staff and external clients/providers, and
process any copay refunds to Members and Providers.
Two years college education, preferably in a health
care or business related field. Bachelor’s Degree in Business Administration
preferred. Three years of Claims Processing Experience in a healthcare or similar
industry that includes one year experience providing Customer Service or Care
or one year experience working with a Practice Management System performing A/R
(Corrections, distributions, and reversing payments and requesting refunds)
duties. Must have knowledge of EZ cap; Must be proficient in the application
and use of Windows, Word, Excel, Outlook and the internet; Thorough knowledge
of insurance benefits covered by contracting health plans.