Job Description:

The Representative III, Care Svc is responsible to perform eligibility verification, authorization of services, adjudication of claims and payment for services benefiting eligible clients.

Review and verify client edibility for services.Document enrollment or follow-up appropriately in client level data application.Receive calls from medical and support providers and authorize services appropriately for eligible clients.Communicate effectively 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 departmental policy and procedure and in accordance with Accounting Department 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 and effective working relationships and partner with internal and external customers by providing superior customer service.Perform other duties that support the overall objective of the position.

Education Required:High School Graduate or General Education Development (GED).Or, any combination of education and experience which would provide the required qualifications for the position.
Experience Required:2+ years' in medical billing and/or collections experience.2+ years' in performing tasks that require a basic understanding of accounting and math skills.Experience using Windows-based programs required; prefer experience working with practice management software.Experience in an office environment utilizing standard office practices and proceduresExperience with Ryan White funded services.Or, any combination of education and experience which would provide the required equivalent qualifications for the position.
 Knowledge, Skills & Abilities:Knowledge of: Working knowledge with Microsoft Office Suite; accounting principles, billing practices.Skill in: Communication, listening, organized and detail oriented, analytical.Ability to: Work in a fast-paced environment; stay organized, prioritize workload, multi-task, and meet deadlines; establish and maintain effective working relationships.

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.