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Provider Customer Services Representative, MI - Remote
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Job Description
- Req#: 25004249
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Fully remote position, offering flexibility in your work environment
- Opportunity for career advancement and growth within the organization
- Engaging work culture focused on employee development and quality service
- Chance to be an advocate for providers and enhance healthcare delivery
- Competitive salary commensurate with experience
What to Expect (Job Responsibilities):
- Handle daily provider telephone calls, addressing issues related to eligibility, benefits, and claims resolution
- Serve as a liaison with the Medical Management Department for service authorizations
- Provide education and information to providers while collaborating with Provider Relations to resolve issues
- Assist members with inquiries regarding eligibility, benefits, and claims concerns
- Advocate for providers to ensure their needs and questions are addressed effectively
What is Required (Qualifications):
- High School Diploma or equivalent certification
- Minimum of two (2) years' experience in a physician healthcare office environment or high-volume call center
How to Stand Out (Preferred Qualifications):
- Associate Degree in business, healthcare, or a related field
- Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO, and Managed Care functions
- In-depth understanding of claims administration related to provider payments, including knowledge of CPT-4 codes, revenue codes, HCPCS codes, and DRGs
#HealthcareServices #ProviderRelations #RemoteWork #CareerOpportunity #ClaimsAdministration
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