Provider Relations Specialist

Innovative Systems Group; Austin (TX); On-site; USD 57,000 - 69,000; Full time

Job summary

Innovative Systems Group is seeking a provider services specialist to support Medicare and Medicaid provider operations. The role involves researching and resolving provider inquiries related to contracts, system issues, data entry claims payments, and directory accuracy.

You will collaborate with Provider Network, Provider Relations, and Government Programs staff to resolve issues and communicate updates. Responsibilities include educating the Medicaid/Medicare provider network on policy

Qualifications

• Bachelor degree OR 2 years of experience in health insurance/managed care industry.
• Strong written and verbal communication skills to educate providers and resolve issues across departments.
• Proficiency in Microsoft Word and Excel.
• HS Diploma or GED.

Responsibilities

• Support Medicare and Medicaid provider services and provider operations.
• Research and resolve provider inquiries related to contracts, systems, data entry claims payments, and directory issues.
• Coordinate internal/external communications to educate providers about policy updates and changes.

Skills

Written communication

Verbal communication

Problem solving

Education

Bachelor degree

HS Diploma/GED

Tools

Microsoft Word

Microsoft Excel

Job description

Pay: $30.30/hr on W2 or $63k conversion salary

This position is responsible for supporting Medicare and Medicaid provider services, provider operations of individual Medicare and Medicaid providers. This position is accountable for researching and resolving provider inquiries arising from contract operations, system, data entry claims payment, and directory issues. This position is responsible for internal communications including working with Provider Network, Provider Relations, and Government Programs staff on issue resolution, This position is responsible for external communications including educating and updating the l Medicaid and Medicare provider network community regarding Blue Cross Blue Shield policy updates, system and contractual changes. Assist in the composition and coordination of revised policies and procedures

JOB REQUIREMENTS:

• Bachelor degree OR 2 year of experience in health insurance/managed care industry handling independent decision making.
• Written and verbal communication skills to compose responses to external and internal entities, to educate providers, to compose training materials and procedures, to work across departments to resolve provider issues including claim research.
• PC proficiency including Microsoft Word and Excel.
• HS Diploma/GED

PREFERRED JOB REQUIREMENTS:

• Bachelor Degree with one year business experience.
• Knowledge of health care industry, contracts, products, claims processing.
• Knowledge of government health care products