Job Expectations Knowledge Check

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Provider Authorization Knowledge Check

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Randi Weeks

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Job Expectations Knowledge Check


Job Expectations Knowledge CheckVersión en línea Provider Authorization Knowledge Check por Randi Weeks 1 What is the primary focus of a Provider Services Representative? a Emotional support for patients b Sales and marketing c Transactional, policy-driven support d Advocacy for members 2 True or False: Provider Services Representatives are expected to advocate for patients during calls a True b False 3 Which of the following is NOT a core duty of a Provider Services Representative? a Quoting plan benefits using approved scripts b Providing emotional reassurance c Initiating authorizations during the call d Documenting calls in the system 4 Why must scripts be read verbatim when quoting benefits? a To save time b To avoid sounding robotic c To ensure consistency and compliance d To make the call more conversational 5 What should you do if a provider asks for clarification on a benefit script? a Paraphrase the script b Offer a brief, accurate explanation aligned with the script c Skip the disclaimer d Transfer the call 6 True or False: After-call work should be completed in DND mode whenever possible a True b False 7 Which of the following is an example of precise, professional language? a I'm so sorry, that's really unfortunate. b Let me check on that for you, sweetie. c Authorization is required for CPT 99214 under this plan. d I think it might be covered, but I'm not sure. 8 Which extension handles authorization-related calls? a 1321 b 1320 c 1318 d 1322 9 True or False: All benefit calls should be transferred to THG regardless of the service type a True b False 10 What is the main reason authorization calls are handled in-house? a They are shorter b They are less important c They are higher risk and more complex d They involve billing questions 11 What are the two types of authorizations reviewed by the Care Management team? a HLOS b Pre-d c none of the above d answers A and B 12 True or False: Approval from Care Management guarantees payment of benefits. a True b False 13 What should you do if a provider calls to request a retroactive review? a Tell them it's not allowed b Transfer to Care Management c Follow the standard process for initiating authorization d Ignore the request 14 Which of the following behaviors should be avoided during provider calls? a Using technical language b Over-apologizing c Sticking to the script d Providing disclaimers 15 What must be included in every call log? (Select all that apply) Choose one or more answers a CPT codes b Caller's favorite color c Date of service d Authorization status 16 True or False: Provider Services Representatives should use casual phrasing to build rapport. a True b False c d 17 What is the purpose of the Pre-D process? a To determine medical necessity b To guarantee payment c To determine the benefit amounts d To verify if the provider is in network 18 Which of the following services require Pre-Determination? (Select all that apply) Choose one or more answers a Inpatient admission b Outpatient surgical procedures c Infusion therapy d Preventive screenings 19 What is the fax number for sending clinical documentation to Care Management? a 281-368-7359 b 281-368-7382 c 888-221-1140 d 281-368-7380 20 What should you do before submitting a new referral in NE360? a Submit immediately b Check if a referral already exists c Ask the provider to call back d Skip the documentation

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Job Expectations Knowledge CheckVersión en línea

por Randi Weeks

What is the primary focus of a Provider Services Representative?

True or False: Provider Services Representatives are expected to advocate for patients during calls

Which of the following is NOT a core duty of a Provider Services Representative?

Why must scripts be read verbatim when quoting benefits?

What should you do if a provider asks for clarification on a benefit script?

True or False: After-call work should be completed in DND mode whenever possible

Which of the following is an example of precise, professional language?

Which extension handles authorization-related calls?

True or False: All benefit calls should be transferred to THG regardless of the service type

What is the main reason authorization calls are handled in-house?

What are the two types of authorizations reviewed by the Care Management team?

True or False: Approval from Care Management guarantees payment of benefits.

What should you do if a provider calls to request a retroactive review?

Which of the following behaviors should be avoided during provider calls?

What must be included in every call log? (Select all that apply)

True or False: Provider Services Representatives should use casual phrasing to build rapport.

What is the purpose of the Pre-D process?

Which of the following services require Pre-Determination? (Select all that apply)

What is the fax number for sending clinical documentation to Care Management?

What should you do before submitting a new referral in NE360?