Provider Experience Center Representative

Primary City/State:

Arizona, Arizona

Department Name:

Provider Relations

Work Shift:

Day

Job Category:

Marketing and Communications

Great careers are built at Banner Health. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote work options. Apply today, this could be the perfect opportunity for you.

As a Provider Experience Center Representative, you will provide expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. You will provide customer service to providers and serve as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. You may also be assigned to work in a variety of administrative duties relative to supporting the provider community. Experience inCustomer Service, Billing and Coding, working in a high-volume call center or similar position is needed in this role. Familiarity with Health Insurance and benefits, Medicare and Medicaid plan knowledge is desired. This is a remote position with a shift within the hours of 7:30AM and 8:00AM start time. Schedule is discussed at the time of interview, dependent on the business need.

Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in health care. In addition, we recently made Newsweek’s list of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. It highlights our commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement.

Banner Health Network (BHN) is an accountable care organization that joins Arizona''s largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY
This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. May be assigned to work in a variety of administrative duties relative to supporting the provider community.
CORE FUNCTIONS
1. Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.)
2. Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department’s ongoing goals and objectives.
3. Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians’ office staff.
4. Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms.
5. Assists internal departments in resolving provider appeals pertaining to the organization’s physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organization’s insurance plan administration staff.
6. Works on special projects as assigned.
7. Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network. Makes decisions within structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion. Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur. Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with minimal supervision and instruction.
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
Must have substantial previous related work experience in healthcare services, with three to four years of experience in a high volume service center or managed care environment. Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at all times.
Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills. Must have the ability to acquire and utilize a sound knowledge of the company’s provider information systems, as well as, fundamental knowledge of the organization’s expectations. Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall Provider Experience.
PREFERRED QUALIFICATIONS

Experience with a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate’s degree. The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology.
Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

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