Provider Relations Representative, Sr. jobs in Niagara Falls, NY

To be considered for this position you must apply on our company's career page using the direct link below:

https://ih.wd1.myworkdayjobs.com/en-US/IHA_Careers/details/Provider-Relations-Representative_R0009220

Our Benefits Include:

• For the 16th consecutive year, Independent Health has been named one of the best companies to work for in NYS
• Free Health, Vision, and Dental Insurance for the employee and their family
• Company Provided Life Insurance
• Company Provided Short-Term and Long-Term Disability, and Extended Leave
• Workplace Flexibility
• Employee Assistance Program
• Educational Assistance
• 401k Match
• Adoption Assistance
• Wellness program and Nutrition Benefits
• Generous Paid Time Off
• Paid Holidays
• Free Virtual Wellness Classes
• Volunteer Opportunities and a community focus

Job Description:

This is a great opportunity to join Independent Health and our family of companies! We are hiring full-time Provider Relations Representatives to start on May 22, 2023.

Training: Approximately 16 weeks of on-site paid training Monday-Friday, 8am - 4pm (250 Essjay Rd and then 511 Farber Lakes Dr)

Schedule: Associates will be assigned a regular shift, 8:30am-4:30pm/ 9:00am-5:00pm/ 9:30am-5:30pm (shift preference discussed at the mid-point of training).

Benefits: As a full-time associate, you are eligible to receive benefits; Medical, Dental, Vision, 401K, and paid time off (PTO), including company paid holidays.

The Provider Relations Representative position offers an opportunity to begin a career at Independent Health. All new employees who successfully complete training will be eligible to work a hybrid schedule - from home and from the office depending on business needs.

Overview

The Provider Relations Representative is responsible for assisting our provider constituents and providing exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary provider offices and facilities and aid with benefit and eligibility questions, billing and payment questions, and EOB explanations. The Provider Relations Representative will focus on first call resolution and navigate various systems and programs efficiently to provide the caller with the appropriate information to resolve their issues. The Provider Relations Representative will develop a relationship with the office staff by providing confident and accurate responses to customer inquiries in a collaborative and professional manner. The Provider Relations Representative will be accountable to meet all performance measures established in the call center include efficiency and quality metrics as well as first call resolution and attendance.

Qualifications

• High School Diploma or GED required.
• Two (2) years of experience in the health care industry or working in a provider office required.
• Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred.
• Experience in Compliance regulations, appeals and grievance knowledge preferred.
• Demonstrated ability to effectively communicate with internal and external customers.
• Excellent written/verbal communication skills and excellent customer service skills required.
• Demonstrated “conflict resolution” skills.
• Demonstrated ability to resolve customer complaints in writing.
• Demonstrated proficiency in problem solving and proven ability to prioritize accordingly.
• PC and Windows experience with proficient typing skills and ability to utilize multiple system tools simultaneously.
• Strong organizational/time management skills.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

Servicing and Grievance Appeal Team

• Research and respond to escalated and complex provider and member inquiries, including claim and billing research requests.
• Provide written and verbal response to customer inquiries.
• Identify and analyze educational opportunities internally or externally.
• Identify potential system configuration or billing issues and provide education to the provider to correct errors.
• Responsible for acting as a customer advocate by providing excellent and accurate customer service when responding to customer requests.
• Utilize up-to-date knowledge of managed care criteria to meet department of health standards.
• Responsible for escalating issues as needed to supervisor.
• Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines.
• Goals: To meet or exceed all department standards in the following categories: Quality goals-measure Representative’s ability to consistently respond to customer with excellent customer service.

Productivity goals-measure Representative’s ability to be productive and use time effectively and efficiently. Includes the volume of correspondence worked daily as well as measuring tardiness and attendance. Accuracy goals-measure Representative’s ability to respond to inquiries correctly and accurately.

Technical Proficiency

• Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies and procedures and maintaining updates daily. Attend required training sessions as needed.
• Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State ,CMS etc.), addressing first level complaints and assisting appeals as needed; receive and effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers.
• Knowledge of all systems (Siebel, Health Rules, RX Claims, P&W, WNYHealtheNet, MACESS, Focus, E-mail and other systems as needed and the ability to coordinate the use of these tools at the same time.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.