Provider Service Representative
Job Detail
Title: Provider Service Representative
Location : Indianapolis, IN
Description:
THESE POSITIONS ARE FOR APPLICANTS LOOKING FOR TEMP TO PERM ASSIGNMENTS
This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, working with Provider Relations to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.
Essential Functions and Responsibilities:
1. Meets the Department call metric standards and issues/diaries entered.
2. Assists Providers and Members as needed with questions and concerns.
• Answer billing/claims status questions; resolve claim issues for providers
• Assist with pharmacy issues
• Verify member eligibility
• Quote benefits
• Assist with Referrals
3. Ongoing Provider education.
4. Responsible for all benefits information given to Providers and Members.
5. Participates in Departmental Projects, as appropriate.
6. Coordinates quality improvement initiatives with Medical Management, Provider Relations, and Quality Depts., i.e., HEDIS improvement, Provider education.
7. Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.
*** This is a 52% markup need. Contractors need to make a facility mandated *** per hour ***