Provider Relations Representative

Independent Health is an organization that values growth, innovation, and collaboration. They are hiring full-time Provider Relations Representatives to assist healthcare providers with inquiries related to benefits, billing, and eligibility while providing exceptional customer service.

Responsibilities

• Research and respond to escalated and complex provider and member inquiries, including claim and billing research requests
• Provide written and verbal response to customer inquiries
• Identify and analyze educational opportunities internally or externally
• Identify potential system configuration or billing issues and provide education to the provider to correct errors
• Act as a customer advocate by providing excellent, accurate customer service when responding to customer requests
• Utilize up-to-date knowledge of managed care criteria to meet department of health standards
• Escalate issues as needed to supervisor
• Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines
• Meet or exceed all department standards in quality, productivity, and accuracy
• Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies and procedures and updates daily. Attend required training sessions as needed
• Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed; effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers
• Knowledge of all systems as needed and the ability to coordinate the use of these tools at the same time

Skills

• High school diploma or GED required
• Prior experience in customer service required, preferably in a healthcare setting
• Excellent written/verbal communication skills and excellent customer service skills required
• Ability to resolve conflicts effectively and customer complaints in writing
• Strong problem-solving skills with ability to prioritize tasks effectively
• Strong organizational and time management skills
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable
• Experience working with provider offices is strongly preferred
• Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred
• Experience in compliance regulations, appeals and grievance knowledge preferred

Benefits

• Incentive
• Full range of benefits
• Generous paid time off

Company Overview