What are the responsibilities and job description for the Senior, Provider Services Advocate position at Independent Living Systems?
ABOUT US
Join us in making a career at Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Senior Provider Services Advocate responds to Provider telephone inquiries for identification and elevation of issues to management. Resolves mostly routine and some non-routine, more complex problems and communicates solutions or requested information to the customer.
Essential Functions
- Provide world class service to our providers by responding to provider issues and inquiries that are received via the telephone.
- Review, research, and respond to inquiries from Providers.
- Identify issues based on provider inquiries and elevate those issues management.
- Analyze database to identify problems / issues pertaining to claim processing.
- Immediately complete claim adjustments and/or claim processing upon request.
- Document computer system to track inquiry.
- Serve as a subject matter expert amongst peers.
- Ensures that escalated issues are managed and documented to excellent professional standards.
- Performs call monitoring and auditing of Provider Service inquiries using call recording software.
- Identifies trends / issues / deficiencies related to service quality provided by Call Center staff; makes recommendations for modifications and / or improvements to streamline processes and improve service to Providers.
- Keeps management informed of quality issues / trends adversely impacting service levels.
- Meet departmental statistical goals.
- Complete miscellaneous assignments upon request.
- Maintain production and quality scores as follows:
- Maintain production and quality scores as follows:
- Logged In Time: Approximately 08:30:00 hours.
- Average Hold Time: Approximately 00:01 :00.
- Completes a minimum of 15 audits per assigned agent per month.
Education And Experience
- High School Diploma/GED required; college course work preferred.
- Medical background preferred.
- Experience processing UB04 and CMS 1500 claims a plus.
- Demonstrated proficiency in Microsoft programs (i.e., Excel, Word, PowerPoint) required; knowledge of Microsoft Access preferred.
Required Skills
- Self-starter, conscientious, independent worker.
- Strong knowledge of Customer Service skills and techniques required.
- Excellent written, verbal, and grammatical communication skills required.
- Advanced customer service skills working in a contact center environment.
- Ability to read, interpret, analyze technical / business procedures and / or governmental regulations required.
- Ability to write reports, business correspondence and procedural manuals required.
- Knowledge of automated systems (technical adeptness) required.
EEO STATEMENT
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
