Provider Relations Representative

Independent Health • Buffalo, NY

442d • $41,600 - $41,600

About The Position

The Provider Relations Representative plays a crucial role in assisting healthcare providers by delivering exceptional customer service. This position involves answering calls from various healthcare providers, addressing inquiries related to benefits, eligibility, billing, and payment, while ensuring first call resolution. The representative will build relationships with provider office staff and is accountable for meeting performance metrics in a call center environment.

Requirements

• High School Diploma or GED required.
• Two years of experience in the healthcare industry or working in a provider office required.
• Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM, and HCPCS coding preferred.
• Experience in compliance regulations, appeals, and grievance knowledge preferred.
• Demonstrated ability to effectively communicate with internal and external customers.
• Excellent written and verbal communication skills and customer service skills required.
• Demonstrated conflict resolution skills.
• Proven ability to resolve customer complaints in writing.
• Strong organizational and time management skills.

Nice To Haves

• Knowledge of managed care criteria to meet department of health standards.
• Proficiency in problem solving and prioritization.

Responsibilities

• Answer incoming calls from healthcare providers and assist with benefit and eligibility questions.
• Aid with billing and payment inquiries, including EOB explanations.
• Focus on first call resolution and navigate various systems to provide accurate information.
• Develop relationships with provider office staff through confident and accurate responses.
• Meet performance measures established in the call center, including efficiency and quality metrics.
• Research and respond to escalated and complex provider and member inquiries.
• Provide written and verbal responses to customer inquiries.
• Identify educational opportunities and potential system configuration or billing issues.
• Act as a customer advocate by providing excellent customer service.
• Log all contacts into appropriate systems and maintain accurate documentation.

Benefits

• Scorecard incentive eligibility
• Full range of benefits
• Generous paid time off

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED