Provider Relations Representative, Sr. jobs in Wyoming, MI
Provider Relations Representative, Sr. supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. May provide guidance or expertise to less experienced representatives. Being a Provider Relations Representative, Sr. typically requires a bachelor's degree. Typically reports to a supervisor or manager. The Provider Relations Representative, Sr. gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Relations Representative, Sr. typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Provider Relations Representative, Sr. jobs
- Corewell Health
-
Grand Rapids, MI
FULL_TIME
-
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 RapidsDepartment Name
Employment Type
Full timeShift
Weekly Scheduled Hours
40Hours of Work
Days Worked
Weekend Frequency
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
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.
- 4 Days Ago
- Michigan School Public Relations Association
-
Allegan, MI
FULL_TIME
- Position Details JOB SUMMARY : The Student Support Coordinator is responsible for student success through the implementation, integration, alignment, and coordination of the community school strategy,...
- 22 Days Ago
- KPG Provider Services, LLC
-
Allegan, MI
FULL_TIME
- Inpatient Facility: Looking for an experienced Hospitalist NP/PA in the Allegan, Michigan area. Below you will find the Position Overview with all the detail regarding the position. Position Overview ...
- 13 Days Ago
- LTC Provider Care
-
Grandville, MI
FULL_TIME
- LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
- 1 Month Ago
- LTC Provider Care
-
Big Rapids, MI
FULL_TIME
- LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
- 1 Month Ago
- LTC Provider Care
-
Greenville, MI
FULL_TIME
- LTC Physician Care is a new and emerging medical group dedicated to serving patients across the care continuum focusing specifically on Skilled Nursing and Long-Term Care facility settings, to improve...
- 1 Month Ago
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- Wyoming, MI
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0 Provider Relations Representative, Sr. jobs found in Wyoming, MI area
- Meijer Credit Union
-
Grand Rapids, MI
- Description Creating A financial peace of mind for our members is what we do at Meijer Credit Union. Originally establis...
- 4/19/2024 12:00:00 AM
- Walmart
-
Grand Rapids, MI
- **Job Title: Customer Service Representative (Walmart)** **Job Summary:** As a Customer Service Representative at Walmar...
- 4/19/2024 12:00:00 AM
- Xtend
-
Grand Rapids, MI
- POSITION SUMMARY The Member Services Representative Level 1 is responsible for providing day-to-day support for credit u...
- 4/19/2024 12:00:00 AM
- Spectrum Health Lakeland
-
Grand Rapids, MI
- **CURRENT SPECTRUM HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career...
- 4/19/2024 12:00:00 AM
- USSC Acquisition Corp
-
Grand Rapids, MI
- Job Type Full-time Description United Safety and Survivability Corporation is committed to delivering the most innovativ...
- 4/18/2024 12:00:00 AM
- X-Rite Incorporated
-
Grand Rapids, MI
- **Customer Service Representative** X-Rite Pantone Location Grand Rapids, Michigan, United States of America Category Cu...
- 4/18/2024 12:00:00 AM
- Trinity Health Corporation
-
Grand Rapids, MI
- Employment Type: Full time Shift: Description: All shifts available, part-time and full-time hours, multiple locations! ...
- 4/16/2024 12:00:00 AM
- Time4Learning
-
Hudsonville, MI
- [Customer Support / Fully Remote] - Anywhere in U.S. / Competitive pay / Ability to work east coast hours - As a Custome...
- 4/16/2024 12:00:00 AM
About Wyoming, Michigan
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