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Lead Provider Service Representative

Company: Centene
Location: Irving
Posted on: July 14, 2019

Job Description:

Lead Provider Service Representative Position Purpose: Act as liaison between Provider Service Representatives, management and other departments. Responsible for resolving provider and customer inquiries via telephone and written correspondence in a timely and appropriate manner. Coordinate the day to day work function of the provider services area, acting as a 'go to' person and investigating and resolving complex issues. - Answer and document all calls for reporting and resolution through the phone log system (MACESS) - Own the process through resolution and closure - Answer phone inquiries from providers regarding claim, eligibility, covered benefits, and authorization status issues. - Respond proactively to provider issues and concerns and give feedback to management. - Initiate or fax necessary forms to provider to release pending claims. - Follow up on open MACESS reports to make sure that CSFs have been resolved timely and accurately. - Work with other departments on cross functional tasks and projects. - Assist in training new Provider Service Representatives. - Investigate and resolve complex claims issues/projects in coordination with health plan and/or corporate departments - Initiate change requests to resolve system configuration issues impacting claims processing and user test results - Provide education to providers regarding proper claims billing procedures in accordance with health plan, State and Federal regulations on site, telephonically or other media - On at least a quarterly basis, provide training opportunities for Provider Services, and Provider Relations Field Specialists - Provide management with a weekly update on all projects Education/Experience: High school diploma or equivalent. 5+ years of experience in healthcare or insurance customer service and 3 years of managed care experience. Knowledge of Amisys and/or MACESS preferred. License/Certification: Registered Health Information Administrator or Registered Health Information Technician preferred. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Customer Service USA-Texas-Irving Envolve People Care Full-time

Keywords: Centene, Irving , Lead Provider Service Representative, Sales , Irving, Texas

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