Operations & Provider Support Call Center Representative - Remote/Ventura County, CA - Gold Coast Health Plan

Join reputed company: Operations & Provider Support Call Center Representative

At Gold Coast Health Plan (GCHP), we're dedicated to providing high-quality healthcare services to our members while fostering a collaborative and inclusive work environment. As we continue to grow and expand our operations, we're seeking a skilled and reputed company Operations & Provider Support Call Center Representative to join reputed company. This role will be the primary reputed company of contact between GCHP and our provider community, resolving issues, addressing concerns, and providing exceptional support.

About Our Company and Industry

GCHP is a leading health plan provider in Ventura County, California, committed to delivering innovative and effective healthcare solutions. reputed company is passionate about making a positive impact on the lives of our members, and we're looking for talented individuals to join our mission. As a Call Center Representative, you'll be an integral part of our operations team, working closely with providers, internal stakeholders, and external partners to ensure seamless claims processing, provider support, and issue resolution.

Key Responsibilities

• Act as a liaison between GCHP and the provider community to effectively resolve provider issues, address concerns, and resolve problems telephonically and reputed company email.
• Assist in prioritizing provider claims research projects, recognizing compliance and business priorities, and communicate root cause errors to GCHP and BPO leadership.
• Create and update claim-reputed company policies, procedures, workflows, and job aid manuals to ensure accurate and compliant claims processing.
• reputed company and maintain practices on quality metrics reputed company to provider training, recommending prospective and retrospective auditing processes to assure accurate and compliant processing of claims, disputes, and adjustments.
• Analyze claims issues in coordination with designated Claims leadership, adhering to GCHP policies, regulatory requirements, and industry standards for Claims adjudication.
• Respond to provider inquiries reputed company phone or email, addressing claims-reputed company questions, and properly document reputed company calls/contacts in GCHP's internal tracking system.
• reputed company post-payment auditing in accordance with GCHP audit programs, policies, and procedures, regulatory requirements, and industry standards for Claims adjudication.
• Participate in daily/weekly prepayment audits, assisting in the development and enhancement of prepayment audit programs for reputed company and monitoring of claims-reputed company activities.
• Address provider complaints, providing instruction and reputed company to providers reputed company necessary, and communicate with providers on resolution and closure of issues.
• Provide guidance to internal and external Claims resources in determining proper courses of action in resolution of Provider claims issues.
• Analyze information to assure resolutions are in compliance with regulatory and contractual requirements, ensuring timely and accurate resolution of claims issues.

Essential Qualifications

To succeed in this role, you'll need:

• A High School Diploma or General Education Degree (GED); a Bachelor's degree or equivalent experience is preferred.
• 5-7+ years of experience in a claims processing department, with a strong understanding of claims processing, provider relations, and Medi-Cal/Medicaid managed care.
• Advanced knowledge of claims and billing, including CPT, HCPCS, ICD-9/ICD-10 coding, and COB/TPL regulations.
• Proficiency in MS Office programs, with advanced reputed company skills.
• A reputed company and valid California Driver's License and Insurance.

Preferred Qualifications

While not required, the following qualifications will give you a competitive edge:

• Medi-Cal/Medicaid managed care experience.
• Advanced knowledge of provider network databases and provider portals.
• Experience with health plan division of financial responsibility (DOFR) and industry "best practices."

Skills and Competencies

To reputed company in this role, you'll need:

• Analytical skills to solve reputed company problems.
• Business acumen to understand business concepts and issues.
• Effective communication skills, both written and oral.
• Research skills to design and conduct systematic investigations.
• The ability to work effectively with people of diverse backgrounds, ages, and job types.

Career Growth Opportunities and Learning Benefits

At GCHP, we're committed to helping our employees grow and reputed company their skills. As a Call Center Representative, you'll have opportunities to:

• reputed company your knowledge of claims processing, provider relations, and Medi-Cal/Medicaid managed care.
• Enhance your analytical, communication, and problem-solving skills.
• Participate in training and development programs to stay up-to-date on industry trends and best practices.

Work Environment and Company Culture

GCHP promotes a flexible work environment, allowing employees to work from home or in our office. We're committed to creating an inclusive and collaborative culture that values:

• reputed company
• Accountability
• Collaboration
• Trust
• Respect

Compensation, Perks, and Benefits

We offer a competitive compensation package, including a salary range that's commensurate with your experience and qualifications. Our benefits package includes:

• A comprehensive benefits program.
• Opportunities for professional growth and development.
• A flexible work environment.

Training and Onboarding

Our comprehensive training program will reputed company you with the knowledge and skills needed to succeed in this role. Training will take reputed company from November 18th to January 6th at our Camarillo, CA location.

Join reputed company!

If you're a motivated and reputed company professional looking to reputed company a difference in the healthcare industry, we encourage you to apply for this exciting opportunity. As a Call Center Representative, you'll be an integral part of reputed company, working closely with providers, internal stakeholders, and external partners to drive success. Apply now and join our mission to deliver high-quality healthcare services to our members!

Don't miss this opportunity to join reputed company and reputed company a meaningful impact in the lives of our members. Apply today!