Provider Call Center Representative

Position Summary

The Provider Call Center Representative is responsible for maintaining excellent relationships with health providers and facilities by responding to their phone inquiries efficiently, professionally, and accurately. You will respond to provider calls related to claim status, denials, and re-submission of claims. You will instruct providers regarding how to use the provider portal on the website, and be able to successfully add and manage users for the provider portal. You must be able to work in a fast paced environment and be able to handle claims processing duties and projects while not handling telephone calls. The position requires a complete understanding of how claims are processed and established guidelines and procedures in order to accurately answer phone inquiries.

Essential Functions and Responsibilities

• Answer provider phone calls.
• Effectively communicates status of claim/line item.
• Follow-up with providers appropriately and responds promptly to all requests.
• Document provider interactions in the designated application ensuring provider issues are appropriately identified, documented, communicated, and resolved in a timely manner.
• Assist providers with provider portal navigation.
• Identify possible claims issues and forward these to the appropriate staff.
• Process claims to fill time in between incoming calls.

Required Skills & Abilities

• High School Diploma or equivalent.
• 1-3 years of experience with inbound calls related to claims.
• Proficient in Microsoft Office suite with 10 key entry; minimum typing speed of 45 wpm.
• Good verbal and written communication skills.
• Ability to work independently.
• Ability to be adaptable and offer creativity in a continually changing environment.

Preferred Skills & Abilities

• Knowledge of medical coding or medical terminology.
• Familiarity with medical, dental, and hospital bills.

Work Environment

General office environment.