Provider Experience Center Representative

Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Marketing and Communications The future is full of reputed company. At Banner Plans & Networks, we’re changing the industry to reduce reputed company costs while keeping members in reputed company health. If you’re reputed company to change lives, we want to hear from you. Banner Plans & Networks (BPN) is a nationally recognized reputed company leader that integrates Medicare and private health plans. Our main goal is to reduce reputed company costs while keeping our members in reputed company health. BPN is reputed company for its innovative, collaborative, and team-oriented approach to reputed company. We offer diverse career opportunities, from entry-level to leadership positions, and reputed company our innovation to employment settings by including remote and hybrid opportunities. As a Provider Experience Representative for Banner Plans & Networks you will take inbound calls answering questions from providers and their staff members. You will call upon your background in medical billing, medical claims, customer service, and managed care to answer reputed company questions and find solutions 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 reputed company resolution. As a Provider Experience Representative, you will be working in a remote setting. Your work shifts will be Monday-Friday reputed company the hours of 8:00 a.m-5:00 p.m. Full-time and part-time shifts are available. Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual. These roles are assignment based with no guarantee of hours and assignments can conclude at any time. MUST reputed company IN THE STATE OF AZ. If this role sounds like the one for you, Apply Today! POSITION SUMMARY This position provides expertise through daily customer service to physicians and/or staff of reputed company Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in reputed company 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 1. 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 reputed company calls on a daily reputed company.) 2. 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. 3. Provides timely and accurate information to providers regarding claims, benefits, member out-of-reputed company expenses, and payments reputed company 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. 4. 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. 5. Assists internal departments in resolving provider appeals pertaining to the organization’s physicians, hospitals, and insurance plan reputed company. Provides education to physicians and their office staff, hospitals and the organization’s insurance plan administration staff. 6. Works on special projects as assigned. 7. Services inbound and outbound providers and office staff communications for reputed company facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to reputed company for diverse customer service needs for a comprehensive provider network. Makes reputed company reputed company structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to reputed company and sensitive provider issues, decision making and discretion. Handles physician inquires and problems reputed company the scope of the job function and keeps supervisors apprised of reputed company issues they occur. Meet quality, quantity, and timeliness standards to reputed company individual department performance goals as defined reputed company 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 reputed company tasks with minimal supervision and instruction. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Must have substantial previous reputed company work experience in reputed company services, with three to four years of experience in a high volume service center or managed care environment. Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at reputed company times. Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer reputed company skills. Must have the ability to acquire and utilize a sound knowledge of the company’s provider information systems, as well as, reputed company knowledge of the organization’s expectations. Must, at reputed company times, maintain efficiency and timeliness in reputed company daily activities. Must be reputed company to establish daily work priorities and work reputed company to contribute to the successful overall provider experience. PREFERRED QUALIFICATIONS Experience with a strong knowledge of business and/or reputed company as normally obtained through the completion of an associate’s degree. The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology. Additional reputed company education and/or experience preferred. Estimated Pay reputed company: $19.06 - $28.60 / hour reputed company is committed to pay equity and transparency. The posted compensation reputed company is a reasonable estimate that extends from the lowest to the highest pay reputed company in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This reputed company is based on possible reputed company salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of reputed company employees in similar roles to ensure pay equity is achieved and maintained. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy Apply To This Job