Provider Relations Representative

Independent Health Association; Buffalo (NY); On-site; USD 40,000 - 44,000; Full time

Job summary

Independent Health Association in Buffalo, NY seeks a Provider Relations Representative to assist our provider constituents and deliver exceptional customer service by answering calls about benefits, eligibility, billing and EOB explanations.

You will focus on first call resolution, navigate multiple systems, build relationships with office staff, and uphold performance metrics such as quality and productivity.

Qualifications

• High school diploma or GED required.
• Prior customer service experience, preferably in a healthcare setting, with provider office experience preferred.
• Knowledge of CPT/ICD-9-CM/ICD-10-CM and HCPCS coding preferred.
• Experience in compliance regulations, appeals and grievance knowledge preferred.
• Excellent written/verbal communication and customer service skills required.
• Ability to resolve conflicts effectively and handle written complaints.
• Strong problem-solving, organizational and time-management skills.
• Demonstrates IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Responsibilities

• Research and respond to escalated provider and member inquiries, including claim and billing research requests.
• Provide written and verbal responses to customer inquiries.
• Identify educational opportunities internally or externally.
• Identify system configuration or billing issues and educate providers to correct errors.
• Act as a customer advocate by providing excellent, accurate customer service.
• Utilize current knowledge of managed care criteria to meet standards.
• Escalate issues to supervisor as needed.
• Log all contacts and maintain documentation for audits.
• Meet or exceed department standards in quality, productivity, and accuracy.
• Maintain knowledge of contracts and benefits; attend required trainings.
• Document information in systems to meet regulatory standards (NCQA, State, CMS).
• Coordinate use of multiple systems as needed.

Skills

Customer service

Provider offices experience

Medical coding knowledge

Compliance knowledge

Communication

Verbal communication

Written communication

Conflict resolution

Problem solving

Time management

Education

High school diploma or GED

Job description

Overview

The Provider Relations Representative will be responsible for assisting our provider constituents and providing exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary provider offices and facilities and aid with benefit and eligibility questions, billing and payment questions, and EOB explanations. The Provider Relations Representative will focus on first call resolution and navigate various systems and programs efficiently to provide the caller with the appropriate information to resolve their issues. The Provider Relations Representative will develop a relationship with the office staff by providing confident and accurate responses to customer inquiries in a collaborative and professional manner. They will be accountable to meet all performance measures established in the call center to include efficiency and quality metrics as well as first call resolution and attendance.

Qualifications

• High school diploma or GED required.
• Prior experience in customer service required, preferably in a healthcare setting. Experience working with provider offices is strongly preferred. Proven history in a high-volume work environment where organizational and multi-tasking skills are essential.
• Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred.
• Experience in compliance regulations, appeals and grievance knowledge preferred.
• Ability to effectively communicate with internal and external customers.
• Excellent written/verbal communication skills and excellent customer service skills required.
• Ability to resolve conflicts effectively and customer complaints in writing.
• Strong problem‑solving skills with ability to prioritize tasks effectively.
• Strong organizational and time‑management skills.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

• Research and respond to escalated and complex provider and member inquiries, including claim and billing research requests.
• Provide written and verbal response to customer inquiries.
• Identify and analyze educational opportunities internally or externally.
• Identify potential system configuration or billing issues and provide education to the provider to correct errors.
• Act as a customer advocate by providing excellent, accurate customer service when responding to customer requests.
• Utilize up-to-date knowledge of managed care criteria to meet department of health standards.
• Escalate issues as needed to supervisor.
• Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines.
• Meet or exceed all department standards in quality, productivity, and accuracy.
• Maintain technical knowledge regarding Independent Health's contracts and benefits and working knowledge of policies and procedures and updates daily. Attend required training sessions as needed.
• Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed; effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers.
• Knowledge of all systems as needed and the ability to coordinate the use of these tools at the same time.

Compensation & Benefits

Hiring Compensation Range: $20.00 hourly. Compensation may vary based on factors including but not limited to skills, education, location and experience. In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off.

Legal and Equal Opportunity Statement

Immigration or work visa sponsorship will not be provided for this position.

As an Equal Opportunity / AffirMitive Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

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