Appeal Clinical Operations Representative at TurningPoint Healthcare

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Full Time

Start Date

Immediate

Expiry Date

30 Sep, 26

Salary

0.0

Posted On

02 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Healthcare Operations, Verbal Communication, Written Communication, Organizational Skills, Multitasking, Problem Solving, Data Entry, Microsoft Word, Microsoft Excel, Microsoft Outlook, HIPAA Compliance

Industry

Hospitals and Health Care

Description

Appeal Clinical Operations Representative Shift 9:30am- 6:00pm Who We Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system. Position Summary: The Appeals clinical operations representative will assist in the day-to-day activities related to Appeals. This position serves clients by taking fax and e-mail requests, processing requests, and providing information. Roles and Responsibilities: * Takes requests by obtaining and verifying information * Enters requests by transmitting information * Reviews requests from clients for completeness of information * Provides clients information by answering questions and offering assistance * Makes outbound calls to providers, as needed or required by client * Improves quality results by recommending changes and providing feedback * Suggests modifications to for our portal, web design and back-end information * Keeps equipment operational by following established procedures and reporting malfunctions. * Updates job knowledge by participating in educational opportunities and training * Enhances organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments * Follows company policies and procedures and conducts annual performance reviews in a timely manner * Respects and maintains HIPAA confidentiality guidelines * Other duties as directed Education, Experience and Licensure: * Minimum of 2 years’ experience in Customer Service, or any healthcare operations is required * Excellent verbal and written communication skills * Must possess strong organizational skills; ability to multitask; commitment to customer service; ability to problem solve * Must be able to foster a positive and productive work environment Preferred Education, Experience and Licensure: * Associate’s degree in a business or health related field * Phone Queue Experience, Outlook, and Data Entry Skills * Intermediate to advance proficiency in Microsoft Word, Excel and Outlook TurningPoint Healthcare Solutions is an Equal Opportunity Employer.

Responsibilities

The representative manages day-to-day appeals activities by processing fax and email requests and verifying client information. They also handle outbound calls to providers and suggest improvements for the company portal and web design.