Provider Services Customer Service Representative
Ask Allegiance - Missoula, MT

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Through a respectful, constructive and energetic style guided by the objectives of the company, negotiates contracts and works to establish and enhance effective working relationships between Allegiance and its Providers. The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position. ESSENTIAL JOB FUNCTIONS: Essential job functions include the following. Other functions may be assigned as business conditions change.Third Party Network CoordinationCoordinate all Payor/Allegiance correspondence around network access.Respond to emails and calls from the Payor team regarding network providers.Review and respond to network provider disputes regarding Payor claims re-pricing.Document and distribute provider disputes regarding claims processing to the Payor team.Identify and address network issues as they arise. Answer provider questions and find solutions to challenges around Payor.Identify network growth opportunities for Payor membership utilization.Update provider page regularly.Follow up on all outstanding provider disputes and questions regarding Payor network accessProvider OutreachAssist in provider outreach for the purpose of updating provider databaseAssist with set up/schedule provider visits for provider relations teamProvider CommunicationCollect information for quarterly newsletter regarding Payor network accessCoordinate provider mailings (mail merge, tracking, mailing, etc.) Follow up on all outstanding provider disputes and questions regarding Allegiance Provider DirectAdministrationPreparation & mailing of provider communication Assist with provider phone calls and questionsSend out fee schedules as directedTrack, index and mail out contracts, amendments and credentialing paperwork NON-ESSENTIAL JOB FUNCTIONS: Performs related or other assigned duties as required or directed.PHYSICAL WORKING CONDITIONS: Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Sitting 50% Reaching SomeStanding 25% Manual Dexterity MediumWalking 25% Telephone YesKneeling Some Computer Screen MediumBending Some Lifting up to 20 lbs.Travel MinimalJOB SPECIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Minimum Education: High school diploma or GED equivalent.Certification(s) Required: NoneMinimum Experience: One year experience in the health care or health insurance industry preferred.Other Qualifications: Excellent oral and written communication skills required.Strong PC skills, including Windows, Word, Excel and Adobe Acrobat. Must be able to adapt to software changes as they occur.High level of interpersonal skills to work effectively with others. Strong communications, listening, facilitation and consulting skills.Excellent project management skills.Demonstrated ability to be a change agent and foster innovative solutions.Develop a sound understanding of different networks offered and how they operateDevelop a sound understanding of claims processing for multiple payorsJudgment and tact to resolve conflicting priorities from multiple parties.Ability to project a professional image and positive attitude in any work environment.Ability to comply with privacy and confidentiality standards.Ability to be flexible, work under pressure and meet deadlines.Ability to analyze and solve problems with professionalism and patience.Ability to operate typical office equipment.

Keywords: Provider Networking, Insurance,

Ask Allegiance - 16 months ago - save job - block
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