• Provider Benefit Expert

    Job Location US-MI-Detroit
    Job ID
    Customer Service/Support
    Business Line
    CMC Corporate
  • Overview

    Who we are:


    Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


    We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


    Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.


    A Day in the Life of a Provider Benefit Expert:

    This position is responsible for the processing all inbound provider calls for Medicaid, Medicare and HIX lines of business.  This position requires general knowledge of claims processing, authorization processes and provider benefits. This position operates out of a phone queue and provides exceptional quality customer service to all providers. 


    • Work within a call center environment to process incoming and outgoing telephonic contacts with providers
    • Adhere to workforce management schedules in order to ensure departmental goals are met
    • Conduct inbound telephonic contact with providers in a professional manner and maintain phone stats according to departmental goals
    • Assist Medicaid, Medicare and HIX providers with identified needs during telephonic contacts
    • Determine if procedures require prior authorization by checking CPT codes at the request of providers
    • Assist providers by entering authorizations over the phone, when applicable
    • Fax processed authorization requests back to appropriate provider offices
    • Provide regular or complex claim status to providers over the phone
    • Run check tracers at the request of providers for lost or expired checks 
    • Educate providers on MHP policies and procedures regarding access to care, grievance and appeal process, eligibility process, HIPAA, rights and responsibilities, and fraud, waste and abuse
    • Educate providers on Meridian Health policies and procedures regarding access to care, grievance and appeal process and eligibility process
    • Consistently demonstrates compliance with HIPAA regulations, professional conduct and ethical practice
    • Provide excellent customer service to providers and internally to all Caidan Management Staff
    • Remain updated on all provider policy changes made by MHP, the State, or accrediting entities
    • Perform accurate data entry into MHP systems and software programs
    • May be required to work holidays and/or observed holidays as requested by leadership
    • Perform other duties as assigned


    What you can bring to Meridian:

    • High school diploma is required.
    • Bachelor’s degree in one of the following areas is preferred: Allied Health, Business Administration (with a focus in Health Services Administration), Health and Fitness Management, Health Sciences (with a focus in Behavioral Health), Health Services Administration, Healthcare Administration, Healthcare Management, Nursing, Nutrition, Public Safety, Pharmacy, Psychology, Public Health or Social Work

    • One year of customer service experience or related health care industry experience is preferred
    • Knowledge of managed care or Medicaid/Medicare and Exchange programs is helpful
    • Familiarity with Medical Terminology, ICD-10, and CPT codes
    • Must be familiar with ODAG, claims ledger, timely filing process, and appeal and denial processes
    • Solid understanding of the full adjudication process
    • Excellent verbal and written communication skills are required
    • Intermediate computer skills are required
    • Interpersonal skills
    • Research and follow-through skills
    • Organizational and team skills

    What Meridian can offer you:


    • Our healthcare benefits include a variety of plans that are effective on the first day of employment for our new full-time team members.
    • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
    • Meridian offers 401k matching that is above the national average.
    • Full-time Meridian employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
    • Meridian was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.


    Equal Opportunity Employer


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