Provider Relations Representative
$41,600–$41,600 year
On-siteBuffalo, New York, United States
Job Summary
Answer incoming calls from physician offices and facilities regarding benefit eligibility, billing, and EOB explanations. Resolve first-call issues by navigating systems efficiently and providing accurate responses to inquiries about claims, reimbursement, and participating providers. Research escalated and complex inquiries, analyze billing errors, and educate providers to correct system configuration issues. Document all contacts in appropriate systems to meet external audit guidelines and escalate unresolved matters to supervisors. Maintain daily technical knowledge of managed care criteria and policies while addressing first-level complaints and assisting with appeals.
Required Qualifications
- High school diploma or GED
- Prior experience in customer service
- Ability to effectively communicate with internal and external customers
- Excellent written/verbal communication skills
- Excellent customer service skills
- Ability to resolve conflicts effectively and customer complaints in writing
- Strong problem-solving skills
- Ability to prioritize tasks effectively
- Strong organizational and time management skills
- Passionate
- Caring
- Respectful
- Trustworthy
- Collaborative
- Accountable
- Immigration or work visa sponsorship will not be provided for this position
Desired Qualifications
- Experience working with provider offices
- Proven history in a high-volume work environment
- Organizational and multi-tasking skills
- Strong working knowledge of CPT, ICD-9-CM, ICD-10-CM and HCPCS coding
- Experience in compliance regulations, appeals and grievance knowledge
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