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Representative III, Care Services

Company: NextGen Healthcare
Location: Saint Louis
Posted on: January 15, 2022

Job Description:

Job Responsibilities:

* 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 working relationships and partner with internal and external customers by providing superior customer service.

Required Qualifications:

* Minimum of 2 year of experience in Medical billing and/or collections experience and standard office practices and procedures.
* 2 plus years of experience in performing tasks that require a basic understanding of accounting, math skills or equivalent education.
* High School Graduate or General Education Degree (GED): Required.
* Previous experience with Excel and Windows based programs required; prefer experience working with practice management software.

Desired Qualifications:

* Bachelor's Degree: Preferred.
* Experience with Ryan White funded services preferred.

NextGen Healthcare believes in strength through diversity. We are an equal opportunity workplace and an affirmative action employer supporting Diversity, Disabled, and Protected Veterans. Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, gender identity, disability or veteran status.

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Because NextGen Healthcare believes in providing a safe work environment, we conduct background checks as part of our hiring processes.


Under general supervision, perform eligibility verification, authorization of services, adjudication of claims and payment for services benefiting eligible clients. Develop and maintain effective working relationships with, client referral sources, medical and support service providers, funders and clients.

1836 Lackland Hill Parkway, St. Louis, Missouri 63146

Keywords: NextGen Healthcare, St. Louis , Representative III, Care Services, Sales , Saint Louis, Missouri

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