Novitas Solutions Inc. Hiring for Provider Services Advocate at Mechanicsburg, Pennsylvania Full Time

Reference #: GUIDUS30273EXTERNALENUS10503
Are you interested in joining a team of experienced healthcare experts
and have the ability to shape and transform the healthcare delivery
system? At our family of companies, everything we do is to help improve
the lives of the nearly 12 million Medicare beneficiaries we serve and
700,000 health care providers who care for them. It is our goal to help
create a better health experience for all consumers. Join our winning
culture and help transform Medicare for the millions of people who rely
on its services.
We are currently hiring for Provider Services Advocates (PSAs). As a
PSA, you will be responsible for responding to telephone inquiries from
doctor’s offices and hospitals who are currently authorized to work
with Medicare Part A and Part B patients. You will be provided paid
training, which typically lasts eight to tenweeks. Training hours are
Monday – Friday, between 8 a.m. to 5:30 p.m. (EST). Following training,
work hours are Monday – Friday, 9:30 a.m. to 6 p.m. (EST) (lunch and
breaks are scheduled).
Benefits info:
* Medical, dental, vision, life and supplemental insurance plans
effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
Responds to Medicare Part A and/or B telephone and/or written inquiries
from the Medicare provider community which includes billing offices,
medical societies, provider consultants, Managed Care Organizations,
attorneys, etc. regarding Medicare coverage guidelines and policies
covering a wide range of topics to include provider enrollment, Medicare
appeals, debt recovery, claim payment information, telephone reopening
requests, and general coverage for multiple provider specialties.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform
each essential duty satisfactorily. Reasonable accommodations may be
made to enable individuals with disabilities to perform the essential
functions. This list of essential job functions is not exhaustive and
may be supplemented as necessary.
Customer Service: 50%
* Engage in dialogue with all customers using a customer-friendly tone
even when challenged with overly aggressive customers.
* Respond to each customer’s need and request and ensure each
customer’s encounter is positive and productive.
* Use good verbal and written communication during each customer
encounter and never use jargon and slang.
* Embrace diverse backgrounds and understand the needs of those
customers who may not have as extensive knowledge of Medicare rules and
regulations. Tailor responses to ensure customers receive the maximum
benefit when calling Medicare.
Research and Problem Identification: 25%
* Access multiple systems to research customer problems and record
inquiry types.
* Research CMS and company websites to provide knowledge and education
to customer on additional resources which can be used in the future.
* Access the IVR and Internet Portal systems as needed to help educate
customers on self-service options that are available to them.

Problem solving and Analysis: 25%
* Review claims processing systems to identify specific claim edits and
audits applied on claims.
* Analyze claim edits and audits to determine reasons for claim
denials.
* Review debt recovery systems to troubleshoot reasons for pending
accounts receivables and the generation of overpayment demand letters.
Review and analyze data to determine reasons for overpayments.
* Review local medical coverage and national medical coverage policies
in order to troubleshoot reasons for claim denials and reducti ns.
* Review other system to address and determine resolution to other
customer issues to include pending appeals, aged claims, and Medicare
Secondary Payer.
REQUIRED QUALIFICATIONS
* High School Diploma or GED
* 1 year related work experience
* This includes experience in call center, customer focus, or claims
experience
* Proficient with Microsoft Office to include Outlook
* Demonstrated Internet research skills
* Strong problem solving and decision making skills
* Good listening and strong verbal communication skills
PREFERRED QUALIFICATIONS
* Some college education
* Experience in the insurance industry or medical coding or related
work experience
* Bilingual skills
The first 180 days of employment will be a probationary period. You will
meet with your manager for a feedback session at the end of the
probationary period and complete an evaluation to determine the success
of the probationary period. If it is determined the probationary period
is to be extended, your manager will let you know the specific period of
time of the extension.

The Federal Government and the Centers for Medicare & Medicaid Services
(CMS) may require applicants to have lived in the United States for a
minimum of three (3) years out of the last five (5) years to be employed
with the Company. These years of residence do not have to be
consecutive.

“We are an Equal Opportunity Employer/Protected Veteran/Disabled”

Novitas Solutions, Inc. is an Equal Opportunity Employer – Protected
Veteran/Disabled