Provider Contact Center Specialist
Position Title: Provider Contact Center Specialist
Department: Business IT & Claims Administration
Reports To: Provider Contact Center & Claims Examination Manager
Status: Full Time, Non-Exempt
Hours: Monday – Friday
Supervision: This position does not supervise any other staff
Date Updated: May 2023
Summary: This position is responsible for being the first point of contact for providers who communicate with PrimeWest Health about accuracy and timeliness of claims payments, prior authorizations, Appeal procedures, product information, benefit/eligibility verification, and general plan information. This position identifies member/provider issues and responds accordingly.
Reporting Accountability (if applicable) N/A
Role and Key Responsibilities
Assist the Provider Contact Center Manager and PrimeWest Health staff in the following as needed:
- Provider Contact Center
- Answer inbound calls from providers and work to resolve their questions/concerns regarding eligibility, claims, authorizations, and program issues
- Place outbound calls to providers to provide follow-up on provider-generated issues and education when a claim processing issue is identified
- Ensure timely and accurate response to calls
- Remain up-to-date on Minnesota Department of Human Services/Centers for Medicare & Medicaid Services (DHS/CMS) requirements and PrimeWest Health Provider Manual changes and provider updates
- Confirm accuracy of information given to members/providers
- Initiate contact with the Provider Contact Center Coordinator & Provider Contact Center Manager when an issue can’t be resolved immediately and route the caller to the appropriate staff person for resolution
- Alert management of repeat phone calls due to issues that have not been resolved within standards
- Assist in providing excellent customer service by performing ad hoc duties as defined by the Provider Contact Center & Claims Examination Manager
- Assist with provider web portal registration as assigned Assist with reprocessing and claims adjustments as assigned
- Identify system processing issues and communicate them to appropriate staff for resolution
Other duties as assigned
General PrimeWest Health Responsibilities
- Abide by the PrimeWest Health Code of Conduct Comply with all PrimeWest Health policies and procedures Comply with the Health Insurance Portability and Accountability Act (HIPAA) and all other privacy laws Be familiar with building safety procedures and alert maintenance if something requires attention Keep public areas of the department and office neat and clean Conduct other responsibilities and activities as needed and assigned
Professional Competencies Call center experience is preferred
Educational Requirements and Required Qualifications
- At minimum, an Associate degree and/or two or more years of experience in medical claims Demonstrated knowledge of, and proficiency in, Microsoft Office applications Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills, including the ability to provide effective training in one-to-one or group settings. Ability to display a high level of confidence when responding to phone inquiries Ability to maintain confidentiality regarding member and provider information, as well as other issues deemed confidential Willingness to work hours necessary to successfully accomplish assigned tasks Excellent customer service skills Motivated self-starter who requires little direction Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 5 pounds. Some travel may be required.
Appropriate Licensure and Certification Requirements - N/A
Collaborative Efforts with Other Departments
- Administrative Services Care & Population Health Management Corporate Compliance & Auditing Information Systems & Technology Member & Provider Services Operations Pharmacy Management Quality & Utilization Management
Supervision - N/A
This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.
Location: Alexandria, Minnesota
PrimeWest Health will accept resumes until filled. Employment to begin ASAP.
PrimeWest Health is an Equal Opportunity Employer Committed to Diversity, Equity, and Inclusion