Provider Relations Associate Analyst

Claims & PR (Provider Relations) Advocate

Contractors will initially be trained to take calls regarding eligibility and benefits from behavioral health providers. This initial training is required before learning how to service claim and provider relations calls. Timing for the claim and provider relations training is yet to be determined and will be based on business need.

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues. The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing requests, provider contract questions or requests to update demographics. Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call. Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.

Responsibilities:

• Answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
• Assist a member or provider with understanding how a claim has processed
• Verify claim status for a member or provider
• Educate a member or provider on billing protocols
• Write or correct authorizations to ensure claims are paid correctly
• Send claims for adjustment/reprocessing
• Request duplicate EOBs for a member or provider
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check
• Provide follow-up on issues by making outbound calls when necessary
• Send resources to members and providers via email
• Submit a complaint on the member or provider's behalf
• Send handoff requests to matrix partners for escalated or complex issues
• Assist providers with contract related inquiries and demographic updates
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved.

Candidates must possess superb interpersonal communication skills, effective listening and organizational skills, with the ability to manage multiple tasks. Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications are essential. Strong time management skills and ability to type effectively with strong PC skills are also required.

Training hours are Monday through Friday 8:30 AM - 5:00 PM CST. After all of the training is completed, the hours for this position will be 10:30am-7:00pm CST.