PROVIDER SUPPORT REPRESENTATIVE - Health New England : Job Details

Purpose

Contributes to the overall success of the Provider Experience team by ensuring specific individual goals, plans, initiatives are executed / delivered in support of the team's business strategies and objectives. Ensures all activities conducted are in compliance with governing regulations, internal policies and procedures.

Accountabilities

* Champions a customer focused culture to deepen client relationships and leverage broader Health New England's relationships, systems and knowledge.

* Understand how Health New England's culture and the CX Promise should be considered in day-to-day activities and decisions.

* Actively pursues effective and efficient operations of their respective areas in accordance with Health New England's Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.

* Champions a high performance environment and contributes to an inclusive work environment.

* Accepts inbound calls and email inquiries/requests from providers and responds according to the processes, procedures, and decision matrices referenced in the team training.

* Employs the on-line resources to ensure that consistent and accurate information is relayed to providers with regard to inquiries and requests etc.

* Researches low to medium complexity issues using established protocols and communicates to providers using approved media and standards.

* Follows the established processes and procedures for addressing or reassigning provider inquiries, requests, or grievances including: root cause determination, standard and non-standard resolution options, expected timelines for resolution and provider communication protocols.

* Identifies escalated issues and leverages the Provider Support team as well as other HNE functional areas to diffuse situations.

* Documents interactions, resolution, or reassignment of issues in the established repository tools and within the established standards and timeframes.

Position: Provider Support Representative/Provider Experience

Reporting Relationships (Job Titles only)

Primary Manager:

(include secondary Manager if applicable)

* Manager of Provider Experience

Direct Reports:

* None

Shared Reports (solid/dotted if applicable):

* None

External/Internal Contacts

Internal

* Provider Appeals

* Provider Operations

* Claims & Claims Operations (Configuration)

* Healthcare Services

External

* Individual and group practices

* Third party billing agencies

Education / Experience / Other Information (include only those that are specific to the role)

Bachelor's degree or an equivalent combination of education and experience in business or a related field with a minimum of five years health care/provider servicing experience

* Demonstrated proficiency in the area of provider servicing, support, and issue resolution

* Basic knowledge of provider reimbursement and claims payment mechanisms

* Broad based knowledge of Medicare, Medicaid, and commercial product offerings

* Proficiency with Microsoft applications and applications specific to HNE