PROVIDER SERVICE REP I in Latham, NY at Beacon Health Options

Date Posted: 5/22/2018

Job Snapshot

Job Description

General Summary    

Under the direction of the National Customer Service Management Team, the Provider Service Representative I will provide support to ValueOptions’ internal departments by providing research, problem resolution and follow-up on a variety of provider issues that may arise.  The Provider Service Representative is responsible for answering and responding to a high volume of telephone inquiries from network practitioners and facilities. The Provider Service Representative is responsible for portraying a positive image to the provider community. This includes demonstrating clear and concise communication regarding provider maintenance, written and electronic communications, recruitment, education pertaining to network policies, credentialing paperwork, contracting and fee schedules. The Provider Service Representative is expected to take full accountability for every interaction by providing outstanding service as a means of continually improving provider satisfaction. The Provider Service Representative is expected to promote and train providers in the use of web-based services and make them aware of the educational tools available to them which help streamline the administrative processes. 

Duties and Responsibilities

  1. Maintain professional standards and practice attentive and active listening with a strong focus on establishing a positive rapport with providers.
  2. Perform complete investigation and conduct the necessary follow through on all inquiries regarding the provider nomination and credentialing process. This includes inquiries related to initial applications, exception requests, re-credentialing applications, program changes and contract additions. 
  3. Interpret and effectively communicate information related to provider file maintenance such as demographic and practice information updates.
  4. Research and accurately respond to inquiries regarding the provider disenrollment process, including investigating discrepancies with Network Operations. 
  5. Provide support and training on the use of web-based services. Assist providers in the registration process for face-to-face and webinar forums.
  6. Assist Network Operations by conducting necessary outreach calls to follow up on credentialing applications and related documents to ensure materials are received within the required time frames.  
  7. Work closely with National Network Operations and National Provider Relations to ensure seamless and quality service to providers.
  8. Complete special projects and other tasks as assigned by area management.

Minimum Entry Level Qualifications

  • Education: A high school/GED diploma is required. A Bachelor’s Degree, advanced coursework or technical education or equivalent related experience is preferred.

  • Licensures: N/A

Years and Type of Relevant Work Experience:

  • Three year’s experience in Customer Service, Provider Relations or Health Care/Health Insurance is required. Previous experience in an ACD call center environment is preferred.

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