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Independent Health · 22 hours ago

Provider Relations Representative

Buffalo, NY (14221)

Full-time

Hybrid

New Grad, Entry Level

$20/hr - $20/hr

Independent Health is an organization that values growth, innovation, and collaboration. They are hiring full-time Provider Relations Representatives to assist healthcare providers with inquiries related to benefits, billing, and eligibility while providing exceptional customer service.

Health CareInsuranceNon Profit

No H1B

Responsibilities

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

Act as a customer advocate by providing excellent, accurate customer service when responding to customer requests

Utilize up-to-date knowledge of managed care criteria to meet department of health standards

Escalate issues as needed to supervisor

Log all contacts into appropriate systems and maintain accurate documentation to meet external audit guidelines

Meet or exceed all department standards in quality, productivity, and accuracy

Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies and procedures and 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; effectively resolve written inquiries from customers regarding claims, benefits, eligibility, reimbursement and participating providers

Knowledge of all systems as needed and the ability to coordinate the use of these tools at the same time

Qualification

Customer serviceHealthcare experienceCPT/ICD codingCompliance regulationsConflict resolutionProblem-solvingOrganizational skillsTime managementCommunication skills

Required

High school diploma or GED required

Prior experience in customer service required, preferably in a healthcare setting

Excellent written/verbal communication skills and excellent customer service skills required

Ability to resolve conflicts effectively and customer complaints in writing

Strong problem-solving skills with ability to prioritize tasks effectively

Strong organizational and time management skills

Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable

Preferred

Experience working with provider offices is strongly preferred

Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding preferred

Experience in compliance regulations, appeals and grievance knowledge preferred

Benefits

Incentive

Full range of benefits

Generous paid time off

Company

Independent Health

As one of Western New York's first HMOs, Independent Health covers approximately 355,000 people here and across the country with more than 100 plans, services and products.

Founded in 1980