(Inbound) Provider Services Associate

TalentBurst, an Inc 5000 company; Arlington (VA); Remote; USD 35,000 - 50,000; Full time

Job summary

A leading company is seeking a Provider Services Associate for a remote position based in Arlington, VA. This role involves answering incoming calls, documenting authorizations, and resolving customer inquiries. Ideal candidates will have a high school diploma and at least one year of call center experience, with strong communication and problem-solving skills. The position starts with training and has the potential for full-time conversion based on performance.

Qualifications

• 1 year call center experience required.
• Ability to handle 50-100 calls daily.
• Strong computer skills, including Microsoft applications.

Responsibilities

• Answer incoming calls for authorizations and document in systems.
• Resolve customer complaints as the first line of contact.
• Maintain confidentiality of protected health information.

Skills

Customer Service

Confidentiality

Problem Solving

Communication

Education

High school diploma or GED

Job description

1 day ago Be among the first 25 applicants

• 100 MBPS fiber optic, high speed service and must be able to connect directly to your router via an ethernet cord
• NCH/NIA Provider Services Associate - INBOUND
• New Hire Training: starts MONDAY 6/9/2025
• 4 weeks total: 8am-5pm Central Standard Time
• Schedule after training: all agents MUST be able to work up until 7pm CST, no early shifts available
  
  

Job Title - Provider Services Associate

Job Location - Arlington, VA

Job Duration - 4+ Months

100% REMOTE

• 100 MBPS fiber optic, high speed service and must be able to connect directly to your router via an ethernet cord
• NCH/NIA Provider Services Associate - INBOUND
• New Hire Training: starts MONDAY 6/9/2025
• 4 weeks total: 8am-5pm Central Standard Time
• Schedule after training: all agents MUST be able to work up until 7pm CST, no early shifts available
  
  

Description

• This position is 100 percent remote and part of an operations team that strives to provide first call resolution to a specified set of customers
• You will be responsible for primarily answering incoming calls for new and existing authorizations
• Other responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers
• It is designed to start as a contract role for approximately 5-6 months with the potential to convert into a full-time opportunity depending on your performance and the business' needs
  
  

What You’ll Be Doing

• Understand the end-to-end authorization process, and the business drivers for success.
• Actively listen and probe callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
• Research and communicate information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
• Resolve customer complaints or concerns as the first line of contact.
• Make problem resolution and triage decisions not requiring clinical judgment.
• Discourage unnecessary clinical/physician phone transfers and encourage medical records to be submitted. Help callers understand what clinical information is required.
• Transfer calls to clinicians and physicians only for clinically escalated situations.
• Communicate appeal and denial language to providers and members when appropriate.
• Process withdrawals and other case status changes as needed.
• Understand client and regulatory expectations for accounts in their designated region.
• Recognize and develop relationships with provider groups through repeat calls and provider sensitivities for different health plans.
• Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
• Process fax attachments in between calls.
• Responsible for meeting Service standards in all categories monthly, be a team player, always maintain member and provider confidentiality, demonstrate effective problem-solving skills, be punctual, and maintain good attendance.
• Participate in Service Operations activities as requested that help improve Care Center performance, excellence, and culture.
• Support team members and participate in team activities to help build a high-performance team.
• Demonstrate flexibility in areas such as job duties and schedule to aid Customer Care Operations in better serving its members and help achieve its business and operational goals.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assume responsibility for self-development and career progression.Other duties as assigned by management.
  
  

The Experience You’ll Need - Required!

• High school diploma or GED
• At least 1 year call center experience
• Ability to handle a heavy call volume of 50-100 calls daily
• Ability to maintain strict confidentiality of protected health information
• Demonstrated ability in using computer and Microsoft applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs
• Ability to work regularly scheduled shifts within 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
• Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions
  
  

Additional Experience That Is Preferred

• 2+ years at a health plan, TPA or related call center setting
• Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions
• Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance)
  
  

At Home Workspace Requirements

• This requires a quiet, private workspace without noise and distractions
• Set aside a dedicated location within your home outside of common areas to avoid background noise while on calls with our members and/or providers
• Please be sure that dependent and/or pet care has been resolved before you begin your new position
• Working at home is not a replacement for daycare for children and/or pets
• Your workspace must be able to always maintain privacy during your working hours
• This means your area must be in a secured locked location free from any distractions or ability disclose HIPPA or PHI information
• You may not work remotely in a public place (Coffee shop, park, library, airport, etc), which also includes outside of the country, including any US territory
• If you need to work at a different location, this must be preapproved by your leader
• Your equipment should not be moved from your home location without preapproval by your leader, as this runs the risk of loss of HIPPA and/or PHI information
  
  

Additional Technology Requirements

• All team members are required to have a smartphone so that they can access Microsoft Multi-Factor Authentication & Microsoft Teams
• Due to the use of the NICE application for servicing our inbound and outbound calls, requires that all CSR team members have an internet service that provides 100 MBPS fiber optic, high speed service and must be able to connect directly to your router via an ethernet cord
• The use of WIFI on your laptop will be disabled, as while using NICE will cause dropped calls, and inability to hear voice through your headset
• The below internet services are NOT compatible with the NICE application and are, therefore, NOT acceptable for this role:
• 4G, 5G, LTE or Satellite Internet service, as they are an escalated WIFI / Hot Spot service
  
  

Company Supplied Equipment For CSR Agents

• Dell Laptop/Small PC (dependent on current inventory)
• Power cords
• One large monitor
• Keyboard/Mouse/Headset
• 15-foot Ethernet cable
  
  

#TB_HC Job #: 25-31162

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Contract

Job function

• Job function

  Sales and Business Development

• Industries

  Staffing and Recruiting

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