Provider Relations Associate Analyst

Within a call a Claims & PR Advocate may: Assist a member or provider with understanding how a claim has processed Verify claim status for a member or provider Educate a member or provider on billing protocols Write or correct authorizations to ensure claims are paid correctly Send claims for adjustment/reprocessing. Request duplicate EOBs for a member or provider Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check Provide follow-up on issues by making outbound calls when necessary.

Job Title: Provider Relations Associate Analyst
Duration: 05 months (Possible Extension) 
Location:  100% Remote
 
Scheduled:
Training:
Training hours are Monday through Friday 8:30 AM - 5:00 PM CST.
Work Schedule:
After all the training is completed, the hours for this position will be 10:30am-7:00pm CST.
 
Job Description and Role Summary:

• The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues.
• The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing requests, provider contract questions or requests to update demographics.
• Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call.
• Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.

 
Responsibilities:

• The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
• The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up.

 
Within a call a Claims & PR Advocate may:

• Assist a member or provider with understanding how a claim has processed Verify claim status for a member or provider Educate a member or provider on billing protocols Write or correct authorizations to ensure claims are paid correctly Send claims for adjustment/reprocessing
• Request duplicate EOBs for a member or provider Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check Provide follow-up on issues by making outbound calls when necessary.
• Send resources to members and providers via email Submit a complaint on the member or provider's behalf Send handoff requests to matrix partners for escalated or complex issues
• Assist providers with contract related inquiries and demographic updates
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved.

 
Education:      

• Bachelor’s Degree required.