Provider Relations Representative

NCG Medical is a profitable and growing Revenue Cycle Management firm based outside of Orlando, FL. Our company has over 40 years of a successful track record of developing solutions for private practice physicians. We are continuing to grow and are excited to welcome several new client accounts and are adding to our remote team.

Overview:

The purpose of the Provider Relations Representative is to provide exceptional customer service by working remotely and supporting our claims team and responding to inquiries from our providers. The Provider Relations Representative will answer provider inquiries regarding verification of benefits and claims status for medical claims. The Provider Relations Representatives will also provide a variety of other duties and projects assigned by management to support the company.

Responsibilities:

• Answering incoming calls and tickets related to eligibility, benefits, claims and authorization of services from providers

• Administration of intake documentation into the appropriate systems

• Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call

• Performance expectations are to meet or exceed operations production and quality standardsResponsible for meeting call handling requirements and daily telephone standards as set forth by management; accurately respond to inbound phone calls and processing provider inquiries and requests into the appropriate system and database

• Under general supervision, resolve customers service or billing complaints by demonstrating sound judgment; contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments

• Under general supervision, resolve customer administrative concerns as the first line of contact this may include claim resolutions and other expressions of dissatisfaction; refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation

• Actively listen and probe callers in a professional and timely manner to determine purpose of the calls, keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken

• Under general supervision, research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality

• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies

• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal)

• Educate providers on how to submit claims and when/where to submit a treatment plan

• Under general supervision, perform necessary follow-up tasks to ensure provider needs are completely met

• Support team members and participate in team activities to help build a high-performance team

• Thoroughly document customer comments/information and forward required information to the appropriate staff

• Escalate calls to Call Center Lead when necessary

Required Qualifications:

• High School Diploma or GED

• 1 year of work experience in a healthcare setting

• Type a minimum of 45 words per minute

• Able to use a 10 key by touch

• Microsoft Office – Excel and Word

• Basic understanding of financial accounting, or accounts receivable functions.

• Able to successfully manage multiple tasks, must be able to work in a fast paced environment.

• Professional with very strong communications skills both written and verbal.

• Must be resourceful with the ability to work with various different websites in order to obtain the necessary information to resolve client issues. Must have prior experience working with insurance companies to respite issues and escalations.

• Ability to adapt in using multiple different software programs to facilitate daily workload.

• Flexible to handle unexpected daily challenges.

Desired Qualifications:

• Medical billing and/or client service experience.

• Medical billing experience is required.

Benefits:

• Fully Remote Work Environment
• Competitive Salary
• Medical, Dental, and Vision Insurance
• 401(k) Plan
• Paid Time Off (PTO)
• Paid Holidays
• Birthday Off
• Mental Health Days
• Professional Development Opportunities