[Hiring] Provider Relations Representative @NCG Medical Systems, Inc.

Role Description

The purpose of the Provider Relations Representative is to provide exceptional customer service by working remotely and supporting our claims team and responding to inquiries from our providers. The Provider Relations Representative will answer provider inquiries regarding verification of benefits and claims status for medical claims. The Provider Relations Representatives will also provide a variety of other duties and projects assigned by management to support the company.

Responsibilities:

• Answering incoming calls and tickets related to eligibility, benefits, claims, and authorization of services from providers.
• Administration of intake documentation into the appropriate systems.
• Provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
• Meet or exceed operations production and quality standards.
• Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
• Accurately respond to inbound phone calls and process provider inquiries and requests into the appropriate system and database.
• Resolve customer service or billing complaints by demonstrating sound judgment.
• Contact customers to respond to complex inquiries or notify them of claim investigation results and any planned adjustments.
• Resolve customer administrative concerns as the first line of contact, including claim resolutions and other expressions of dissatisfaction.
• Refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
• Actively listen and probe callers in a professional and timely manner to determine the purpose of the calls.
• Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
• Research and communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Identify and bring to the attention of responsible entities operations problems and/or inefficiencies.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions.
• Educate providers on how to submit claims and when/where to submit a treatment plan.
• Perform necessary follow-up tasks to ensure provider needs are completely met.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly document customer comments/information and forward required information to the appropriate staff.
• Escalate calls to Call Center Lead when necessary.

Qualifications

• High School Diploma or GED.
• 1 year of work experience in a healthcare setting.
• Type a minimum of 45 words per minute.
• Able to use a 10 key by touch.
• Microsoft Office – Excel and Word.
• Basic understanding of financial accounting, or accounts receivable functions.
• Able to successfully manage multiple tasks in a fast-paced environment.
• Professional with very strong communication skills both written and verbal.
• Resourceful with the ability to work with various websites to obtain necessary information to resolve client issues.
• Prior experience working with insurance companies to resolve issues and escalations.
• Ability to adapt to using multiple different software programs to facilitate daily workload.
• Flexible to handle unexpected daily challenges.

Requirements

• Medical billing and/or client service experience.
• Medical billing experience is required.

Benefits

• Fully Remote Work Environment.
• Competitive Salary.
• Medical, Dental, and Vision Insurance.
• 401(k) Plan.
• Paid Time Off (PTO).
• Paid Holidays.
• Birthday Off.
• Mental Health Days.
• Professional Development Opportunities.