Provider Service Representative
Start Date: September 9th 2024Rate of Pay: $18.50Training Schedule: 6 weeksFirst 2 days will be onsite in Grand Rapids, MIMonday to Thursday 8:30 a.m. to 5 p.m.Friday 8 a.m. to 5 p.m.Post Training Hours:Monday to Thursday 8:30 a.m. to 5 p.m.Friday 8 a.m. to 5 p.m.Job SummaryInbound 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.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Relocation assistance (OPTIONAL)
QualificationsRequired
High School Diploma or equivalent
1 year of relevant experience Medical billing, coding, insurance environment relevant to benefits, authorizations, provider contracting, claims processing, and/or managed health care.
Preferred
Associate's Degree
About Corewell HealthAs a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.Primary LocationSITE - Priority Health - 1231 E Beltline - Grand RapidsDepartment NamePH - Provider Call CenterEmployment TypeFull timeShiftDay (United States of America)Weekly Scheduled Hours40Hours of Work8:30 a.m. to 5 p.m.Days WorkedMonday to FridayWeekend FrequencyN/ACURRENT 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.