Provider Experience Center Representative Remote - Phoenix, United States - Banner Health

Banner Health

Verified Company

Phoenix, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Primary City/State:

Arizona, Arizona

Department Name:

Provider Relations

Work Shift:

Day

Job Category:

Marketing and Communications

A rewarding career that fits your life.

As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options.

If you're looking to leverage your abilities - you belong at Banner.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare.

We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Service Center Representative for Banner Plans & Networks you will take inbound calls answering member and provider questions regarding coverage, benefits and other coverage inquiries.

You will be working in a fast paced and multitasking environment while providing excellent customer service and satisfaction with a goal of first call resolution.

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County.

Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers.

The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service.

May be assigned to work in a variety of administrative duties relative to supporting the provider community.

CORE FUNCTIONS

Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.)
Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department's ongoing goals and objectives.
Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians' office staff.
Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms.
Assists internal departments in resolving provider appeals pertaining to the organization's physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organization's insurance plan administration staff.
Works on special projects as assigned.
Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network. Makes decisions within structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion. Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur. Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with mínimal supervision and instruction.

MINIMUM QUALIFICATIONS