Provider Service Representative - #1335941

Job Summary

Start Date: May 13th

Must live within the State of Michigan for Virtual work requirements.

On-site work may be requested if employee performance needs attention, internet issues or power outages that may occur.

6 Weeks of training (2-3 days on-site for equipment education and a meet/greet in Grand Rapids, MI)

No absences will be allowed during training period

Pay $18.50

• based on experience, education and department evaluation.

Inbound call center responsible for the proper and courteous handling of provider contacts regarding complex benefits, authorizations, claims resolution, provider enrollment, policies, national and organizational billing guidelines, and other provider concerns by directing, educating, and facilitating resolution via phone. Promoting provider use of and access to the knowledge, tools, and resources necessary to facilitate the proper application of plan member insurance coverage

Essential Functions

• Receive, service, and resolve provider inquiries, questions, and complaints within all established processes and procedures via phone for Level 1 queues as assigned—including calls pertaining to eligibility, benefits, authorization, claims, pre-service and post service provider appeals, contracting and credentialing, EDI issues, or general provider assistance for Medicaid plans and Medicare plans while maintaining established individual productivity metrics. Leverage provider-specific acumen regarding review of coding and billing guidelines for common and specialty claim submissions, Medicare NCD & LCD guidelines, medical policies, familiarity with EDI claims and eligibility files, and other familiarity with provider enrollment and revenue cycle processes.
• Promote professional and courteous interactions with callers, peers, leaders, and other departments by flexing communication styles as necessary to ensure mutual understanding of concerns and actions, that positive outcomes may be achieved for providers and members within the confines of policy.
• Actively access and leverage available resources, tools, and support, including knowledge articles, medical policies, team procedures, and escalation support, necessary to provide accurate responses to provider questions and concerns.
• Document, route, manage, and otherwise follow up on inquiries in accordance with team procedures.
• Consistently observe scheduled arrival times, breaks, lunches, departures, and other scheduled events as assigned.
• Recognize, promote, and enforce appropriate provider utilization of self-service options as established by team procedures.

Qualifications

• Required High School Diploma or equivalent
• Preferred Associate's Degree

• 1 year of relevant experience Medical billing, coding, insurance environment relevant to benefits, authorizations, provider contracting, claims processing, and/or managed health care. Required

Physical Demands

• Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
• Waist to Waist > 5 lbs: Seldom up to 10 lbs
• Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
• Waist to Overhead > 5 lbs: Seldom up to 10 lbs
• Bilateral Carry > 5 lbs: Seldom up to 10 lbs
• Unilateral Carry > 5 lbs: Seldom up to 10 lbs
• Pushing Force > 5 lbs: Seldom up to 20 lbs
• Pulling Force > 5 lbs: Seldom up to 15 lbs
• Sitting: Frequently
• Standing: Occasionally
• Walking: Occasionally
• Forward Bend - Standing: Seldom
• Forward Bend - Sitting: Occasionally
• Trunk Rotation - Standing: Seldom
• Trunk Rotation - Sitting: Occasionally
• Squat: Seldom
• Stair Climbing: Seldom
• Reach - Above Shoulder: Seldom
• Reach - at Shoulder or Below: Seldom
• Handling: Occasionally
• Forceful Grip > 5 lbs: Seldom
• Forceful Pinch > 2 lbs: Seldom
• Finger/Hand Dexterity: Frequently
• Visual Acuity ¹
  [None = No; Seldom = Yes]: Seldom

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

Employment Type

Full time

Shift

Weekly Scheduled Hours

40

Hours of Work

Days Worked

Weekend Frequency

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.