Healthcare Provider & Client Services Specialist

North East Medical Services; Burlingame (CA); On-site; USD 48,000 - 62,000; Full time

Job summary

North East Medical Services in Burlingame, CA is seeking a Provider and Client Services Representative (PCSR) to deliver general admin support to the MSO Department, handling inquiries from physicians, vendors, and clients related to claims processing, utilization management, and value-based care programs.

The role emphasizes clear communication with health plan partners and internal teams, requires organization and PC literacy (Excel/Outlook/Word/PowerPoint), and prefers a BA/BS with healthcare

Qualifications

• BA/BS degree preferred.
• One-year experience in a healthcare setting preferred.
• Excellent communication skills (verbal and written).
• PC literate with strong Excel, Word, PowerPoint, and Outlook skills.
• Detail-oriented and organized with ability to interpret policy.
• Able to work across multiple departments and with external clients.
• Knowledge of managed care and Medicare/Medi-Cal preferred.
• Fluency in English; Chinese (Cantonese/Mandarin) preferred.

Responsibilities

• Provide primary support to MSO Utilization Management and Claims main line, mailbox, voicemails, and faxes.
• Research and understand basic authorizations, claims, provider appeals, and benefit coverage issues.
• Coordinate follow-up activities for resolution with health plans.
• Coordinate investigation activities for member grievances; track progress and report results within required timeframe.
• Assist Value Based Care Programs team with outreach calls and patient care improvement activities.
• Respond promptly to emails and voicemails requiring action.
• Perform other administrative tasks as assigned.

Skills

Verbal communication

Written communication

PC literacy

Excel

Word

PowerPoint

Outlook

Time management

Organizational skills

Multitasking

Education

BA/BS degree preferred

Tools

Excel

Word

PowerPoint

Outlook

Job description

North East Medical Services in Burlingame, CA is seeking a Provider and Client Services Representative (PCSR) to deliver general admin support to the MSO Department, handling inquiries from physicians, vendors, and clients related to claims processing, utilization management, and value-based care programs.

The role emphasizes clear communication with health plan partners and internal teams, requires organization and PC literacy (Excel/Outlook/Word/PowerPoint), and prefers a BA/BS with healthcare