Hennepin Health is looking for a Provider Services Representative to join their team. This position will be responsible for resolving provider issues by responding to inquiries on a day-to-day basis. This encompasses responding to calls from health care providers to help answer questions and resolve issues regarding health care claims and payments. This provides the opportunity to create and positive relationships between the health plan and providers, including physicians, hospitals, larger care systems, ancillary providers, and practice managers.
Location and hours:
This position is remote. Remote workers may be required to come on-site an average of 0 to 12 days a year for work meetings, trainings, or for any other reasons that their supervisor may deem necessary (may include additional days for onboarding and new employee training). Supervisors will provide as much advance notice as practicable.Work hours will be Monday through Friday, 8 a.m. - 4:30 p.m. Based on business needs of this position, hires must live in or relocate to Minnesota.
In this position, you will:
Answer incoming calls from health care providers, physician offices, clinics, hospitals, and members regarding transportation services and act as a backup to the Member Service team.
Identify the type of assistance the providers may need including benefits, eligibility, billing and payments, authorizations for treatment, explanation of benefits, and remits.
Focus on resolving issues on the first call, navigate through the multiple system applications to identify the current status of the issue, and provide an appropriate response to the caller.
Complete the documentation necessary to track provider issue and facilitate the reporting of overall trends.
Conduct follow-up calls to the providers regarding issue resolution outcomes.
Compose correspondence and provider specific reports to trend issues if it affects more than one claim.
Review and process claim appeal and reconsideration forms.
Need to have:
One of the following:
Four or more years of experience in a managed care, commercial insurance, customer service, claims, or provider support role.
Bachelor's degree or higher in public administration, business administration, or other field appropriate to the position.
Nice to have:
Working with providers, including physicians, hospitals, larger care systems, ancillary providers, and practice managers.
Providing customer service in a call center setting.
Working for a health plan with exposure to Minnesota health care programs.
With coding, billing, electronic data interchange (EDI), revenue cycle management, practice management systems.
Working with multiple product lines of business with multiple levels of benefits within each product.
Planning with strong organization skills.
Navigate a computer while on the phone.
Understand multiple system applications.
Research and use strong analytical skills.
Strong interpersonal and verbal communication skills including telephone etiquette.