Under the Provider Network Operations (PNO) Provider Network Management Supervisor's general direction, the PNO Provider Support Representative is responsible for responding to all PNO department queue incoming calls in a courteous and efficient manner, and triaging Client IPA, Provider and Provider office staff telephone inquiries. Provides first class customer service and ensures that all necessary data is collected/completed properly, accurately, and thoroughly. The PNO Provider Support Representative provides customer satisfaction to both internal and external personnel and strives to continuously improve service delivery.
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Records and maintains complete and accurate records of provider communications regarding member service provision according to department documentation requirements
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Works with provider and provider office staff to resolve, triage, or escalate questions concerning provider completion of delegated and contractual duties
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Respond appropriately within skill level and documented departmental policies and when appropriate, seeks department leadership advice when responding to complex phone inquiries
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Follow through in a timely manner on urgent provider requests
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Provides detailed explanation to client, provider and/or provider office staff regarding IPA and provider status and database setup
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Informs Supervisor and Department leadership when potential provider problem is communicated by member regarding provider-member relationship or regarding member concern with care rendered
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Provide exceptional customer service to ensure both Client IPA and contracted provider satisfaction with the IPA
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Assist in various mandatory projects such as provider outreach, compliance requirements, data cleanup, workflow revisions, upkeep of maintenance and other projects as assigned
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Foster open lines of communication with Leadership on any network changes or issues
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Understand and follow the Employee Handbook policies and procedures
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Ensure HIPAA compliance is always observed/performed
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Perform other duties/assignments as needed
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High School Diploma or GED required, Bachelor’s degree in healthcare, human services or related field preferred
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1+ years Managed Care or Healthcare experience in Network Management, a plus
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Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
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EZ-CAP knowledge, a plus
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Strong communication skills, including both oral and written
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Ability to maintain multiple priorities and deadlines, with strong follow through
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Highly motivated with excellent attention to detail
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Ability to work independently and take direction
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Ability to quickly learn and use new software tools
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Demonstrate commitment to the organization’s core values
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Ability to provide and receive constructive job-related feedback