Provider Services Representative

Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

JOB SUMMARY:

The Provider Services Representative will provide outstanding service acting as the primary point of contact for Providers regarding products and services related to CPHL programs. Representative will provide callers with thorough service that builds relationships, resolves issues and increases overall trust and satisfaction.
 

PRIMARY RESPONSIBILITIES:

• Professionally handle incoming inquiries from providers regarding Medicaid Managed Long Term Care, Medicare Advantage and Medicare Part D Prescription Drug Plans including but not limited to inquiries regarding cost, billing, drug coverage, deductible and co-pays, prospective members and others regarding benefits, eligibility, product information, enrollment and/or other customer service inquiries.
• Thoroughly and efficiently gather provider information, assess and fulfill provider needs and educate providers where applicable regarding services as listed above.
• Prepares correspondence, maintains phone and contact logs, and documents call details as appropriate.
• Resolve provider issues via one call resolution guidelines and/or escalated process.
• Meet or exceed company and client performance metrics.
• Maintain a balance between company policy and customer benefit in decision making.
• Continuously evaluate and identify opportunities to drive process improvements that positively impact members.
• Maintains strong knowledge of assigned products/markets and the applicable state and federal regulations.
• Responsible for call disposition or compiling and generating reports as required.
• Assist Network/Provider Operations in special projects as assigned.

EDUCATION AND EXPERIENCE:

• Education Required: High School Diploma - Some College preferred.

Type of Experience

Required:

• 1 + years of experience in customer service/call center required - ideally in the health care industry and strong knowledge of Medicaid and Medicare.
• Strong detail orientation and excellent communication/listening skills.
• Bilingual skills may be required based upon business needs.
• Demonstrated passion for excellence with respect to treating and caring for customers.
• Ability to identify customer needs and clearly articulate product and service offerings.
• Must work a flexible schedule, company observed holidays and occasional overtime when needed.
• Highly developed sense of integrity and commitment to provider satisfaction.
• Team player.

Specific Technical Skills

Preferred:

• Ability to use software and hardware of a computer to complete certain simple to moderately-complex tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine.
• Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.
• Microsoft Office

Certifications/Licensure:

Required: None

Preferred:

NYS Health Insurance Producer License
 

SCOPE INFORMATION

# Direct Reports: N/A
 

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to communicate over the phone and use computer equipment

The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required

Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.