Provider Relations Representative

FIND YOUR FUTUREWe're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.OverviewThe Provider Relations Representative is 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. The Provider Relations Representative will be accountable to meet all performance measures established in the call center include efficiency and quality metrics as well as first call resolution and attendance.QualificationsHigh School Diploma or GED required.Two (2) years of experience in the health care industry or working in a provider office required.Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred.Experience in Compliance regulations, appeals and grievance knowledge preferred.Demonstrated ability to effectively communicate with internal and external customers.Excellent written / verbal communication skills and excellent customer service skills required.Demonstrated “conflict resolution” skills.Demonstrated ability to resolve customer complaints in writing.Demonstrated proficiency in problem solving and proven ability to prioritize accordingly.Strong organizational / time management skills.Proven examples of displaying the IH values : Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.Essential AccountabilitiesServicing and Grievance Appeal Team : 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.Responsible for acting as a customer advocate by providing excellent and accurate customer service when responding to customer requests.Utilize up-to-date knowledge of managed care criteria to meet department of health standards.Responsible for escalating issues as needed to supervisor.Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines.Goals : To meet or exceed all department standards in the following categories : Quality goals-measure Representative’s ability to consistently respond to customer with excellent customer service.Productivity goals-measure Representative’s ability to be productive and use time effectively and efficiently. Includes the volume of correspondence worked daily as well as measuring tardiness and attendance.Accuracy goals-measure Representative’s ability to respond to inquiries correctly and accurately.Technical Proficiency : Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies and procedures and maintaining 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; receive and effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers.Knowledge of all systems (Siebel, Health Rules, RX Claims, P&W, WNYHealtheNet, MACESS, Focus, E-mail and other systems as needed and the ability to coordinate the use of these tools at the same time.I mmigration or work visa sponsorship will not be provided for this positionHiring Compensation Range : $20 hourlyCompensation 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. The base salary range is subject to change and may be modified in the future.As an Equal Opportunity / Affirmative 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. Click here () for additional EEO / AAP or Reasonable Accommodation information.Current Associates must apply internally via the Job Hub app.The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here () to view our Community Reports.Apply today and join us on the journey to a happier, healthier, and more inclusive community.We are a drug-free workplace. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at : accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

Salary : $20