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Provider Relations Representative

Company: EXCEL MSO
Location: San Jose
Posted on: April 8, 2021

Job Description:

Our growing health management organization is seeking a self-motivated Provider Relations Representative. Under the general supervision from the Head of the department. The Provider Relations, the Provider Relations Representative performs a variety of routine and semi-routine tasks requiring a thorough knowledge of organizational policies and procedures. This position will provide administrative and operational support for the Provider Relations/Network Operations Unit.ESSENTIAL DUTIES AND REPONSIBILITIES --* Train and audit Provider Relations Representatives I.* Conduct staff training on phones system.* Audit documentation of staff calls/contacts as required by department standards.* Answer incoming Provider and Member calls, emails and other requests for assistance in a timely manner in accordance to departmental performance targets and provide excellence customer service while doing so.* Assist Providers and Members in navigating pmgmd.com and other health plans websites, encourage and reassure them to become self-sufficient.* Assist Providers and Members with basic inquiries about claims, authorizations, benefits and other issues. This includes working in conjunction with Health Services, Claims, Credentialing and Contracting.* Interacts positively with all departments.* Properly document all calls/contacts as required by department standards.* Participate in regularly scheduled department meetings and trainings.* Escalate complex issues per department standards.* Own problem through to resolution on behalf of the Provider or Member in real time or through comprehensive and timely follow-up with the Provider or Member.* Monitor effective and timely handling of the department inbox and voicemails.* Make outgoing calls to Providers and Members as directed by other departmental needs and initiatives.* Adopt and understand changes in benefits, work processes and systems.* Support continuous improvement of Provider Relations effectiveness through the development, evaluation and refinement of policies and procedures that meet the operational and regulatory goals and requirements.* Maintain strict confidentiality of all sensitive information and issues.* Participate in the Provider Relations/Network Operations Department and other departmental projects and meetings, as needed.* Performs other duties and special projects as assigned.-- -- --QUALIFICATIONS:* AA/AS degree or equivalent experience.* Managed Care experience in areas of customer service, claims payment, claims resolution, and/or provider service preferred.* Knowledge of CMS 1500 and UB 92 forms.* Knowledge of Medical Terminology and CPT Codes.SPECIAL REQUIREMENTS* Strong Customer Service background.* Excellent critical thinking and problem-solving skills.Experience in use of various computer systems software as well as Windows, MS Word, and MS Excel.* Ability to comprehend detailed information and communicate that information in a comprehensible manner.* Good verbal and written (English) communication skills.* Ability to work in collaboration with multiple departments.* Must be self-motivated and able to work with minimal supervision.* Must be team-oriented and focused on achieving organizational goals.* Possess ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the Provider/Member.* Possess ability to quickly build rapport and respond to Providers/Members in a professional manner by identifying and exceeding expectations. (Responding in respectful, timely manner, consistently meeting commitments).* Demonstrated accountability for one's own actions.* Demonstrated the ability to effectively interact with both external and internal customers in difficult situations.* Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and or weekends, as needed.PHYSICAL DEMANDS-- * Constant and close visual work at a desk or computer.* Constant sitting and working at a desk.* Constant data entry using a keyboard and/or mouse.* Constant use of telephone headset.* Frequent verbal and written communication with Providers, Members, internal staff and other business associates by telephone, correspondence, or in person.* Frequent walking and standing.* Lifting infrequent, up to 25 lbs. weight.recblid oy201cb1edv6zszfc2n0g7681wy02j

Keywords: EXCEL MSO, San Jose , Provider Relations Representative, Other , San Jose, California

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