Provider Relations Specialist
On-site · Lansing, Michigan, United States
Job Summary
Provider Relations Specialist I/II servicing internal and external customers via ACD lines, delivering high-quality medical bill review information, and supporting billing determinations. Responsibilities include handling inquiries by phone, email, and fax; documenting and escalating issues; performing technical review of complex medical bills, including modifiers, anesthesia, and psychiatric, and applying state rules and fee schedules; utilizing the Medical Bill Review software and reference libraries to determine appropriateness of codes and charges; reviewing inpatient/outpatient hospital bills and multiple surgeries; referencing CPT/ICD-CM/HCPCS and fee schedules to support findings; ensuring accuracy and compliance with guidelines; and providing dependable, confidential customer service while maintaining data integrity and meeting production/quality standards.
Required Qualifications
- High School Diploma or GED (Provider Relations Specialists I)
- Certificate in Medical Billing (Provider Relations Specialists II)
- Minimum of three-year general office experience for Specialist I
- Two years as Provider Relations Specialist I or three years in an insurance organization with two years of bill review experience for Specialist II
- Excellent customer service skills
- Excellent telephone etiquette
- Knowledge of multi-functional phone system
- Ability to obtain pertinent information from customers
- Knowledge of computers and spreadsheet software
- Typing 40 wpm accurately
- Proofreading for spelling, grammar, punctuation, and format
- Mathematical calculations with ten-key
- Multi-tasking and data entry
- Ability to work with minimal direction
- Strong communication skills
- Attention to detail
- Ability to meet daily production and quality standards
- Preferred: Background in Workers' Compensation; Degree or Certification in Medical Coding
- Experience with ACD telephone system
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