Commonwealth Care Alliance
Provider Services Representative
PayCompetitive
LocationBoston/Massachusetts
Employment typeFull-Time
This job is now closed
Job Description
- Req#: 5001008134206
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Competitive salary
- Opportunity for career advancement and growth within the organization
- Remote work opportunity
- Supportive and collaborative work environment
- Chance to make a positive impact on member care and satisfaction
What to Expect (Job Responsibilities):
- Interface with the employer's provider departments, including credentialing, PDM, Provider Relations, and Contracting
- Answer critical incoming phone calls from providers and respond to inquiries, concerns, and questions about coverage, benefits, eligibility, and authorization status
- Navigate through multiple, complex systems and screens while maintaining caller engagement
- Document all critical information in the appropriate screen and system
- Submit providers' verbal requests for prior authorization and educate providers on the PA review process and required documentation
What is Required (Qualifications):
- Bachelor's Degree or equivalent experience
- Three plus years of experience providing customer-focused service/activities, independently problem-solving, and data entry
- Prior experience working in a Call Center
- Experience using and entering data into electronic medical records
- Proficient knowledge of Microsoft Office Suite
How to Stand Out (Preferred Qualifications):
- Prior experience working in a medical setting
#HealthcareServices #CustomerService #CareerOpportunity #CompetitivePay #TrainingProvided
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Based in Massachusetts, Commonwealth Care Alliance (CCA) is a not-for-profit, community-based healthcare organization dedicated to improving care for individuals who are dually eligible for MassHealth (Medicaid) and Medicare with complex medical, behavioral health and social needs, including persons with disabilities. CCA offers two health plans: Senior Care Options (HMO SNP), for individuals ages 65 and over who have Medicare and MassHealth Standard or only MassHealth Standard; and One Care, a Massachusetts demonstration program for dual eligible individuals ages 21 to 64. These comprehensive health plans provide all the services covered under Medicare and MassHealth, and other benefits as determined necessary by an inter-professional care team in conjunction with CCA’s preferred provider network. For four consecutive years, CCA’s One Care plan received a top consumer rating for quality and access in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) national survey of Medicare-Medicaid Plans (2016, 2017, 2018, and 2019), administered by the Centers for Medicare & Medicaid (CMS).