Healthcare Customer Service Advocate
Benefits and Eligibility Expert
Experienced in handling a VIP client
- Benefits and Eligibility : give accurate information to Providers about the plan benefits of Members which includes plan coverage including the procedures - making sure that the CPT and DX codes were correct and are covered , DME's ,Telemedicine etc. , if the Provider is IN or OUT of network , how much the deductible , copay , coinsurance and out of pocket that the Member will pay ( if there is ) and if the plan is still active or not.
- Prior Authorization : ensure that Prior Authorization is needed or not prior to appointment. And or advice Providers to obtain Retro Authorization if they are unable to obtain one before the service is delivered .
- Claims : provides information about the claim , how much did it pay ,or why no payment made or as to why claim got denied , and discuss options how it can get paid .
- Appeals : provide accurate information to Providers about the status of Appeals and turn around time and detailing the reasons about the delay and follow up via
- Telephone operator : inbound calls from Providers and Members requesting to be connected/ transferred directly to Provider lines or Member lines .
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It DOES NOT indicate skill level.
ID Proof scores are 0 - 99 with 99 being the best. It is calculated based on dozens of data points.
It's intended to help employers know who they're talking to is real, and not a fake identity.