Provider Inquiry Resolution Specialist I (Hybrid)

Henry Ford Health; Troy (MI); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Henry Ford Health's Health Alliance Plan seeks a Provider Inquiry Representative I to handle provider inquiries via phone, mail, and fax in a hybrid Troy, MI setting. You will educate providers on policies, document inquiries in Pega, and maintain HIPAA compliance while resolving issues promptly.

The role requires 2+ years in customer service or healthcare billing and an Associate's Degree or equivalent experience; medical terminology coursework is a plus.

Qualifications

• Associate's Degree in Business or related field, or 4+ years of related experience.
• Course in Medical Terminology is required post-employment.
• Minimum 2 years of recent Customer Service or Call Center experience within the last 3 years.

Responsibilities

• Respond to inquiries by telephone, mail and fax; research and answer inquiries, complaints and appeals.
• Educate providers on policies, procedures, products, and coverage provisions.
• Document all incoming inquiries in Pega to track provider inquiries and communicate trends.
• Maintain confidentiality per Privacy and HIPAA regulations.
• Monitor workflow inbox and ensure timely response to inquiries; contact providers as needed.
• Develop and maintain strong cross-department relationships to meet provider needs.

Skills

Dependable

Multitasking

Communication

Interpersonal skills

Integrity & diplomacy

Microsoft Office

HIPAA compliance

Pega usage

Education

Associate's Degree in Business or related field

Medical Terminology course

Tools

Pega

Job description

Henry Ford Health's Health Alliance Plan seeks a Provider Inquiry Representative I to handle provider inquiries via phone, mail, and fax in a hybrid Troy, MI setting. You will educate providers on policies, document inquiries in Pega, and maintain HIPAA compliance while resolving issues promptly.

The role requires 2+ years in customer service or healthcare billing and an Associate's Degree or equivalent experience; medical terminology coursework is a plus.