Provider Experience Center Representative

Banner Health; United States; Remote; USD 42,000 - 56,000; Full time

Job summary

Banner Plans & Networks is seeking a Provider Experience Representative to handle inbound calls from providers and their staff, leveraging medical billing and customer service expertise to resolve coverage questions.

The role is remote with Monday–Friday daytime shifts; candidates must reside in Arizona and understand enrollment, claims and managed care processes for a national provider network.

Qualifications

• Experience in medical billing and provider customer service.
• Ability to handle high volume inquiries with accuracy.

Responsibilities

• Respond to provider inquiries with established policies and procedures.
• Collaborate with internal teams to ensure timely issue resolution.
• Explain claims, benefits, out-of-pocket costs and payments to providers via phone or written communication.
• Identify and resolve contract interpretation and utilization management issues.
• Assist with provider appeals and educate staff on plans and contracts.
• Handle multiple tasks in a fast-paced environment to meet quality and timeliness goals.

Skills

Customer service

Medical billing

Claims processing

Managed care

Job description

Department Name:

Work Shift: Day

Job Category: Marketing and Communications

The future is full of possibilities. At Banner Plans & Networks, we're changing the industry to reduce healthcare costs while keeping members in optimal health. If you're ready to change lives, we want to hear from you.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Provider Experience Representative for Banner Plans & Networks you will take inbound calls answering questions from providers and their staff members. You will call upon your background in medical billing, medical claims, customer service, and managed care to answer complex questions and find solutions regarding coverage, benefits and other coverage inquiries. You will be working in a fast paced and multitasking environment while providing excellent customer service and satisfaction with a goal of first call resolution.

As a Provider Experience Representative, you will be working in a remote setting. Your work shifts will be Monday-Friday within the hours of 8:00 a.m-5:00 p.m. Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual. These roles are assignment based with no guarantee of hours and assignments can conclude at any time. MUST RESIDE IN THE STATE OF AZ.

POSITION SUMMARY

This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. May be assigned to work in a variety of administrative duties relative to supporting the provider community.

CORE FUNCTIONS

• Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.)


• Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department's ongoing goals and objectives.


• Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians' office staff.


• Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms.


• Assists internal departments in resolving provider appeals pertaining to the organization's physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organization's insurance plan administration staff.


• Works on special projects as assigned.


• Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network. Makes decisions within structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion. Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur. Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with minimal supervision and instruction.