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Provider services representative skills for your resume and career

Updated January 8, 2025
5 min read
Provider services representative example skills
Below we've compiled a list of the most critical provider services representative skills. We ranked the top skills for provider services representatives based on the percentage of resumes they appeared on. For example, 24.3% of provider services representative resumes contained customer service as a skill. Continue reading to find out what skills a provider services representative needs to be successful in the workplace.

15 provider services representative skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how provider services representatives use customer service:
  • Provided navigational support and customer service for individuals providing home chore services to Medicaid recipients during their transition to paperless reporting.
  • Provided customer service and assistance to physicians, assisted office managers regarding review and adjustment of unresolved or disputed claims.

2. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how provider services representatives use data entry:
  • Utilized proprietary software for confidential clientele data entry, retrieval, and benefits and eligibility verification.
  • Performed data entry to submit information necessary for verification and clarification.

3. Patients

Here's how provider services representatives use patients:
  • Updated member information and provided customer satisfaction while informing patients of medical benefits and reprocessing denied medical claims.
  • Demonstrated proficiency in taking patients medical histories, performing vitals, immunizations, recording reason of visit.

4. Medicaid

Here's how provider services representatives use medicaid:
  • Verified Alabama Medicaid recipient insurance eligibility.
  • Provide unbiased assistance to Medicaid providers with questions regarding Medicaid patient eligibility, medical claims statuses, and other program questions.

5. Health Insurance

Here's how provider services representatives use health insurance:
  • Educated inbound customer and provider calls utilizing company scripts to accurately describe benefits and medical policies of their health insurance.
  • Reviewed and investigated outstanding health insurance claims, eligibility and benefit inquiries to ensure quality provider service.

6. Appeals

Here's how provider services representatives use appeals:
  • Communicate with Providers and/or Representatives regarding appeals that do not meet criteria or other relevant provider issues.
  • Answered telephone and written inquiries from medical providers regarding benefit verification, claim status and appeals.

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7. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how provider services representatives use cpt:
  • Worked with providers in determining appropriate CPT and HCPCS codes for billing, along helping to resolve denials.
  • Utilized multiple databases at once to look up the eligibility & benefit information using CPT & ICD-9 codes.

8. HIPAA

Here's how provider services representatives use hipaa:
  • Maintained strictest confidentiality; adhered to all HIPAA guidelines/ regulations.
  • Assisted Providers with patient management provide HIPAA Compliant information.

9. Medical Terminology

Here's how provider services representatives use medical terminology:
  • Completed three months of detailed training on everything from medical terminology to Medicare to system information.
  • Provided beneficiaries with understanding medical terminology of provider claims.

10. Inbound Calls

Here's how provider services representatives use inbound calls:
  • Answered inbound calls from participating and non participating provider about member's eligibility and benefits.
  • Accepted inbound calls from providers seeking patient and provider eligibility status.

11. Fee Schedules

Here's how provider services representatives use fee schedules:
  • Maintain database for accuracy concerning provider demographic, tax identification and fee schedule information.
  • Aided in the development of Provider recruitment for regional networks, Provider education of plans, fee schedules and claim adjudication.

12. Claims Processing

Claims Processing is the entire workflow involved within the insurance company to evaluate a claim before it gets approved. It has many administrative layers such as assessing insurance eligibility, investigating the medical treatments taken, and reviewing medical codes before it settles or denies a claim with the insured healthcare provider.

Here's how provider services representatives use claims processing:
  • Handled provider inquiries regarding medical benefits, prior authorizations and claims processing and explain claims adjustments.
  • Completed claims processing, provided benefit information, and met satisfactory monthly quality assurance scores.

13. Customer Inquiries

Here's how provider services representatives use customer inquiries:
  • Provided accurate and appropriate information for member insurance verification in response to customer inquiries.
  • Provided accurate and appropriate information in response to customer inquiries about benefits and/or claims.

14. Provider Inquiries

Here's how provider services representatives use provider inquiries:
  • Researched and resolved incoming escalated provider inquiries within contract guidelines; educating providers on new protocols, policies, and procedures.
  • Handled provider inquiries and escalated provider issues to management for completion while holding liability and concise judgment decisions.

15. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how provider services representatives use outbound calls:
  • Managed incoming/outbound calls from members and providers working closely with locations with plan information, claims filling and eligibility issues.
  • Make outbound calls to current members (conduct surveys, provide additional information on other services, etc.)
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List of provider services representative skills to add to your resume

Provider services representative skills

The most important skills for a provider services representative resume and required skills for a provider services representative to have include:

  • Customer Service
  • Data Entry
  • Patients
  • Medicaid
  • Health Insurance
  • Appeals
  • CPT
  • HIPAA
  • Medical Terminology
  • Inbound Calls
  • Fee Schedules
  • Claims Processing
  • Customer Inquiries
  • Provider Inquiries
  • Outbound Calls
  • CMS
  • Quality Standards
  • Member Eligibility
  • Provider Relations
  • Provider Contracts
  • ICD-9
  • Provider Satisfaction
  • Claims Issues
  • Medical Claims
  • Provider Community
  • Provider Calls
  • Hippa
  • Plan Benefits
  • Call Tracking
  • EOB
  • Problem Resolution
  • HMO
  • Insurance Benefits
  • Telephone Calls
  • Telephone Inquiries
  • PPO
  • Facets
  • Primary Care
  • Computer System
  • Medical Billing
  • Billing Issues
  • PCP
  • POS
  • HEDIS
  • Process Improvement
  • Payment Issues
  • Procedure Codes
  • Patient Eligibility
  • Patient Benefits

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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