Provider Systems Support Specialist

Provider Systems Support Specialist

Job Summary

Provides systems and transactional support and education to providers via phone and email. This position will function as a resource to providers with questions related to the CareAffiliate and Availity system. This position is proficient at handling all provider systems inquiries. This role requires the ability to interface with providers regularly, ensuring they are informed and empowered to use the platform effectively.

Government Reporting: In Direct

Education & Experience

Required:

• H.S Diploma or G.E.D.
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 2 years of experience in a high-volume customer service, medical office or contact center environment
• Technology literate and experienced in navigating multiple screens or web browsers at one time and proven ability to work independently in a remote work environment.

Preferred:

• Bachelor’s degree in Business, Health Care Administration, or related field
• Health care or provider systems application support experience

Key Responsibilities

• Monitor and triage inbound support requests, ensuring prompt and accurate responses.
• Conducts outbound calls to providers dealing with navigation issues, applying in-depth knowledge of Availity and CareAffiliate solutions, processes, and procedures.
• Interface with providers to understand and resolve issues, offering clear, step-by-step guidance.
• Perform root cause analysis using TriWest internal reports, to provider data challenges and communication with cross-functional teams for escalation.
• Use de-escalation techniques when necessary to ensure a positive provider experience.
• Maintain accurate documentation of interactions to inform future support strategies.
• Stay updated on platform features and product changes to provide accurate support.
• Ensures calls and issues are identified, tracked, reported on and resolved in a timely manner.
• Maintains comprehensive tracking and documentation for all identified issues to completion.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

• Technical Skills - Proficient data entry skills; Ability to resolve problems involving more complex concepts, policies, and procedures
• Communication Skills - Excellent communication skills to explain complex issues clearly; Ability to de-escalate situations and deliver excellent customer service under pressure
• Team-Building / Team Player - Influence the actions and opinions of others in a positive direction and build group commitment
• Problem Solving / Analysis - Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues
• Organizational Skills - Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented
• Multi-Tasking / Time Management - Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment
• Information Management - Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions
• Independent Thinking / Self-Initiative - Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources
• High Intensity Environment - Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow
• Empathy / Customer Service - Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position
• Coping / Flexibility - Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach
• Computer Literacy - Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications
• Commitment to Task - Ability to conform to established policies and procedures; exhibit high motivation

Work Environment

• Ability to cover any work shift 6:00 a.m. - 9:00 p.m. PST M-F, with no travel
• Works within a standard office environment
• Extensive computer work with prolonged sitting and wearing of headset

** This job description indicates the general nature and levels of work expected of the incumbents. It is not designed to cover or contain a comprehensive listing of activities, duties, responsibilities or competencies required of an incumbent. Incumbents may be asked to perform other duties as required. **