Provider Services Representative Michigan

Provider Services Representative

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Provider Services Representative, to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

Position Summary: This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, working with Provider Relations to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.

Qualifications: Required:

• High School Diploma or equivalent certification.
• Two (2) years' experience in a physician health care office environment or high-volume call center.

Preferred:

• Associate Degree in business, health care or related field.
• Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts).
• In-depth understanding of claims administration as it pertains to provider payments, including CPT- 4 codes, revenue codes, HCPCS codes, DRGs, etc.