Remote

Representative II, Care Services

NextGen Healthcare
United States, Georgia
Mar 28, 2025
Job Description: Perform eligibility verification and authorization of services and adjudication of claims for services benefiting eligible clients. Develop and maintain effective working relationships with client referral sources, medical and support service providers, funders, and clients. Perform mail collection/dissemination and claims scanning to appropriate team members for claims entry and processing and reconciliation of programmatic payments. Review and verify client eligibility for services. Document enrollment or follow-up appropriately in client level data application. Receive calls from medical and support providers; authorize services appropriately for eligible clients. Communicate with case managers and providers in circumstances when services cannot be rendered. Receive, determine payer of last resort and process claims as received. Process payments and invoices according to department policy, procedure, and in accordance with Accounting Department's policies and procedures. Contact case managers and providers as needed to collect appropriate information or to resolve patient balances. Collaborate with management to identify systems issues that prevent the efficient delivery of and payment for services. Participate in department planning meetings and contribute to the development of clinical and process improvement projects. Ensure service level and productivity requirements are met as it relates to enrollment, resolution of tasks, and response to inquiries, etc. Develop and maintain positive working relationships and partner with internal and external customers by providing superior customer service. Education Required: High School Diploma or General Educational Development (GED). Or, any combination of education and experience which would provide the required qualifications for the position. Experience Required: 2+ years of experience in medical billing and/or collections. 2+ years of experience performing tasks that require a basic understanding of accounting and math. Knowledge, Skills & Abilities: Knowledge of:Medical billing and collections; customer service best practices; basic medical terminology; HIPAA; laws, regulations, policies, and procedure governing the functional area; Microsoft Office Suit; Windows-based programs. Skill in:Effective communication with cross-functional team members, peers, and management; providing customer service to internal and external clients; problem solving, analytical, and critical thinking; working as member of a team; communicating clearly, concisely, and effectively; establishing and maintaining effective working relationships. Ability to:Build strong internal and external relationships; work independently with limited direction and/or guidance; maintain confidential information; work in a fast-paced environment; stay organized, prioritize workload, multi-task, and meet deadlines. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and/or assign tasks for the employee to perform, as the company may deem appropriate. NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.