[Hiring] Provider Relations Representative @Versant Health

Role Description

The Provider Relations Representative is an experienced customer service professional with excellent interpersonal, verbal, and written communication skills. The Provider Relations Representative serves as the first point of contact for Versant’s provider network. This individual will have the skill set to analyze and problem solve any claims-related issues and make system updates to provider demographic information as needed. This individual must have excellent organizational skills and be able to multi-task. The Provider Relations Representative will assist the Provider Relations Manager with network recruitment activities and provider network updates. He or she will prepare documents for Credentialing, review and monitor provider complaints, grievances, and escalated issues as necessary to the appropriate staff.

Where you will have an impact

• Serve as initial contact and respond to all provider related inquiries with exceptional service and timely responses in a professional and courteous manner.
• Resolve and respond to provider claims issues and complaints:
• Identify and correct fee schedule issues.
• Submit requests for adjustments to Claims.
• Provide education to providers and their office staff regarding processes and changes.
• Accurately update systems with changes in provider information.
• Process recruitment materials and applications received from providers.
• Assist in recruitment projects, network comparisons and data entry.
• Initiate improvements to processes and procedures for Provider Relations that support company and departmental standards and strategic directives.
• Other duties as assigned.

Qualifications

• High school diploma or equivalent is required.
• Preferred Associate’s Degree.
• Three (3) or more years of customer service and administrative experience.
• Preferred experience in a managed health care environment, provider relations and/or customer service.
• Understanding of vision care insurance is a plus.

Requirements

• HIPAA & Security Requirements: All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures.
• Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times.
• Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Benefits

• Comprehensive and competitive total rewards package designed to support your health, financial well-being, and work-life balance.
• Medical, dental, and paid vision coverage.
• Paid time off and company holidays.
• Retirement savings with employer contribution.
• Employee wellness resources.
• Professional development opportunities.
• Additional benefits may include flexible work arrangements, employee assistance programs, and other programs that support you both at work and beyond.