Provider Services Representative

Company: Health Network Solutions, Inc.
Location: Cornelius
Posted on: November 14, 2024

Job Description:

Overview: This position is responsible for the full range of provider relations and service interactions within HNS, including, but not limited to, researching and responding to providers' requests for support and questions about claims processing and payment. As the primary point of contact at HNS, this position is very customer service-oriented and maintains positive relationships with network providers and practice managers. **This is an in-person position.** Description Serve as primary point of contact and liaison between HNS, its network providers, and managed care partners. Receive and respond to provider inquiries and complaints. Provide detailed responses which educate providers on HNS', and its managed care partners', policies and procedures on network participation and claims. Research, analyze, and identify appropriate resolution for provider inquiries regarding claims submission, processing, and payment-related issues. Use pertinent policies and procedures, data, and facts to provide resolution for non-standard requests and issues. Provide training and ongoing education to enable network providers to become more self-sufficient; especially in functions that negatively impact payment if not performed with a high degree of specificity, for example, eligibility confirmation and claims submission. Upon receipt of notification, initiate appropriate modification of provider-related information, including changes in demographic and contact information, and practice location. Recommend policy and procedure revisions to improve provider satisfaction. Maintain detailed documentation of all communication with network providers and managed care partners. Required Qualifications: Bachelor's degree in healthcare related field or equivalent experience. 3+ years of experience in provider relations or managed care claims customer service environment Experience with claims and EOBs Excellent communication skills (written and verbal) Detail-oriented and highly proficient at problem solving Highly organized, excellent time management and prioritization skills Proficiency with Microsoft Office (Word, Excel, Outlook) Preferred Qualifications: Intermediate level of proficiency in provider issue resolution Intermediate level of experience with claims and EOBs Employment Type: Full Time Years Experience: 3 - 5 years Bonus/Commission: No

Keywords: Health Network Solutions, Inc., Huntersville , Provider Services Representative, Sales , Cornelius, North Carolina