Responsible to research and summarize claims issues received by participating facility providers. Summaries are to include volume and financial data to be used to tracking and reporting purposes. Full and complete responses to be returned to facilities within the agreed upon timeframe.
Establish a reasonable timeframe for completion of each project with facility provider, communicate timely and effectively and provide additional support to facility provider as deemed necessary in order to close issues.
Respond to SAWS and GAD memos timely and accurately in order to close internal issues.
Provide supporting information prior to scheduled meetings with participating facility providers and attend meetings when necessary. Conducts appropriate follow ups as agreed to internally and with the facility.
Assist in training participating facilities on Emblemhealth policies, procedures and payment guidelines, website, and any other training needs that may arise.
Supports the Departmental Service Model with specific function(s) as assigned by Manager.