PAR - Provider Inquiry Representative I

This is a hybrid role and requires employees to be in our Toledo office 3 days a week.

Investigates and resolves all inquiries (telephonic, written and faxed) from participating and non-participating hospitals, primary and specialty care physicians, ancillary and allied health care professionals regarding claim status, claim payment, authorization confirmations, facilitations documenting, member eligibility, and benefit eligibility. Meet specific telephone and contact service form performance standards as indicated in the department's quality indicators. Supports the overall operations within the Provider Relations Department.

ESSENTIAL FUNCTIONS:

Requires work to be performed at a remote location on a regular basis (generally 5 days per week) as determined by applicable business unit unless business demands, geography or other factors require adjustments to this requirement.

• Communicated providers appropriate claim status, claims filing requirements including, but not limited to, use of proper billing forms, coding requirements, timely filing limitations, and appeal processes.
• Communicates providers accurate eligibility and benefits to ensure our members receive the proper services. Assists providers with pre-authorization for medical treatment.
• Responses to member inquiries, contacts providers in a timely manner to problem solve issues related to inappropriate billings, assures the contractual obligations of the providers are met.
• Identifies claims that require adjustments. Forwards adjustment requests in a prompt and accurate manner to the Claims Department for adjudication.
• Facilitates resolution of provider escalated or sensitive situations, offers a positive customer service experience, and ensures provider satisfaction.
• Provides support to internal customers. (Member Services, Utilization/Case Management, Provider Relations, etc.) regarding claim/member billing issues to ensure member/provider satisfaction and meets regulatory compliance standards.
• Performs other duties as assigned.

Education and Experience

• Associates degree in business administration or related field or equivalent combination of training and experience.
• 2 years' experience in one or more of the following areas: HMO/PPO customer service, claims submission and/or processing medical terminology, medical billing, CPT, HCPCs, ICD-10, and DRG coding.
• Demonstrated planning, organizational, analytic, and problem-solving skills.
• Ability to handle multiple priorities.
• Strong customer service skills.
• Effective communication skills required.
• Basic PC navigation and MS Office skills preferred.
• Knowledge of standard office procedures and equipment.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance * insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual*s status as a mutual company means we are owned by our policyholders, not stockholders, so we don*t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There*s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We*re not just one of the largest health insurance companies based in Ohio, we*re also the longest running. Founded in 1934, we*re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.