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Become A Provider Services Representative

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Working As A Provider Services Representative

  • Getting Information
  • Interacting With Computers
  • Communicating with Persons Outside Organization
  • Communicating with Supervisors, Peers, or Subordinates
  • Establishing and Maintaining Interpersonal Relationships
  • Deal with People

  • Mostly Sitting

  • Repetitive

  • $32,802

    Average Salary

What Does A Provider Services Representative Do At Healthfirst

* Interacting by phone with customers to provide information in response to inquiries, concerns and questions about their coverage and products Healthfirst offers.
* Transferring calls from members to proper lines of business such as, Enrollment, Provider Services, Claims, Medical Management, etc.
* Following-up on customer inquiries and complaints that have not been resolved.
* Communicating effectively to members to ensure members understand expectations of their concerns.
* Performing research on billing inquires and claims to provide payment and refunds.
* Acting as a liaison between the member and various departments to address concerns.
* Additional duties as assigned

What Does A Provider Services Representative Do At Molina Healthcare

* a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.
* Supports other members of the Provider Services Team when they are in the field.
* Responsible for documenting requests as required in departmental procedures.
* Assists with training of new Provider Services staff members.
* Attends off-site meetings when necessary with medical groups and other providers as needed.
* Complies with required workplace safety standards.
* Job Qualifications
* Required Education
* High School Diploma or equivalent GED
* Required Experience
* year customer service, provider service, or claims experience in a managed care or medical office setting.
* Preferred Education
* Associate's Degree
* Vocational program in Managed Care or some other health care aspect providing a certificate at completion.
* To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
* Molina Healthcare offers a competitive benefits and compensation package.
* Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

What Does A Provider Services Representative Do At Ascension Health

* Gathers necessary demographic and clinical information from patient and enters into appropriate database.
* Seeks appropriate resources to resolve issues about the type, date or location of prescribed procedures.
* Schedules patient procedures in a manner that most efficiently utilizes the patient's time and clinical resources.
* Assists with coordination of activities related to insurance pre-certification/authorization.
* Provides counseling to patient or patient's representative regarding pre-service requirements and instructions.
* Obtains and witnesses patient's signature on all required forms from CMS, Joint Commission, SJPHS and any other regulatory area.
* Provides and explain patient rights and other literature regarding rules and regulations set forth by hospital or local and national government.
* Provides financial education to patients and family on insurance benefits and/or self-pay programs available.
* Explain financial liability and hospital billing process to ensure that patient’s financial commitment to the institution is arranged for service provided.
* Performs all other duties and projects as assigned

What Does A Provider Services Representative Do At Pacificsource Health Plans

* Meet department and company performance and attendance expectations.
* Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
* Perform other duties as assigned.
* Meet department and company performance and attendance expectations.
* Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
* Perform other duties as assigned.
* Qualifications

What Does A Provider Services Representative Do At Unitedhealth Group

* conducting audits and providing feedback to reduce errors and improve processes and performance, maintaining current provider data to ensure the quality of the network, and may be responsible for representing the provider network area on company IT projects, reporting and tracking provider calls and complaints, or for the support, coordination, and production of the paper directory cycles
* Primary Responsibilities: Maintenance of all provider records within the health plan system(s

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How To Become A Provider Services Representative

Customer service representatives typically need a high school diploma and receive on-the-job training to learn the specific skills needed for the job. They should be good at communicating and interacting with people and have some experience using computers.

Education

Customer service representatives typically need a high school diploma.

Training

Customer service representatives usually receive short-term on-the-job training, lasting 2 to 3 weeks. Those who work in finance and insurance may need several months of training to learn more complicated financial regulations.

General customer-service training may focus on procedures for answering questions, information about a company’s products and services, and computer and telephone use. Trainees often work under the guidance of an experienced worker for the first few weeks of employment.

In certain industries, such as finance and insurance, customer service representatives must remain current with changing regulations.

Licenses, Certifications, and Registrations

Customer service representatives who provide information about finance and insurance may need a state license. Although licensing requirements vary by state, they usually include passing a written exam. Some employers and organizations may provide training for these exams.

Important Qualities

Communication skills. Customer service representatives must be able to provide information in writing, by phone, or in person so that customers can understand them.

Customer-service skills. Representatives help companies retain customers by answering their questions and complaints in a helpful and professional manner.

Interpersonal skills. Representatives should be able to create positive interactions with customers.

Listening skills. Representatives must listen carefully and understand a customer’s situation in order to assist them.

Patience. Representatives should be patient and polite, especially when interacting with dissatisfied customers.

Problem-solving skills. Representatives must determine solutions to a customer’s problem. By resolving issues effectively, representatives contribute to customer loyalty and retention.

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Provider Services Representative jobs

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Top Skills for A Provider Services Representative

ProviderInquiriesMemberEligibilityCustomerServiceMedicaidMedicareAdvantageHealthCareProvidersHealthPlanInitiativesInboundCallsProviderIssuesDataEntryIPAMedicalProvidersClaimsProcessingHealthInsurancePhoneCallsCPTMedicalClaimsHMOClaimsIssuesNetworkProviders

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Top Provider Services Representative Skills

  1. Provider Inquiries
  2. Member Eligibility
  3. Customer Service
You can check out examples of real life uses of top skills on resumes here:
  • Conducted research for provider inquiries regarding medical claims status and payments.
  • Responded to inquiries of claims status, grievances, credentialing status, authorizations status, and member eligibility.
  • Provided exceptional customer service as recipient of multiple customer compliment awards.
  • Assisted SC Medicaid recipients with questions regarding their eligibility and benefits.
  • Educate providers on Medicare and Medicare advantage policy guidelines.

Top Provider Services Representative Employers

Provider Services Representative Videos

A Career in Financial Services at TD

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