Provider relations representative Jobs in Tucson, AZ

Job Type

Full-time

Description

Under the direction of the Provider Network Manager, the Provider Relations Specialist is responsible for assisting in a full range of provider relations and service interactions with the provider community, EK Health clients and partners. This position establishes and fosters relationships and works directly with the Bill Review team to resolve all requests related to bill processing.

Position Specifics : Full-time, Non-Exempt position; working Monday through Friday 8-hour work day, Remote

The job responsibilities will include, but are not limited to :

• Accurately and appropriately analyze all types of medical bills based on claim jurisdiction, medical notes, usual and customary rates (UCR), statutory regulations including state laws and fee schedules, available MPN / PPO contracts, coding guidelines, client instructions, and company policies and procedures
• Must be able to understand how a bill was processed and communicate to providers the methodology for processing and re-pricing the bill
• Receive all provider calls, emails and voicemails and respond within 48 hours
• Monitor the bill review process from initial receipt of bills through final payment
• Reviews and verifies the correct use of medical billing codes and reports the detection of improper use of billing codes to Client Inquiries, Enforcer or QA team
• Work with the Bill Review team on all quality assurance issues identified for review and handling
• Communicate with medical providers to obtain needed information to resolve bill-specific issues
• Communicate directly with clients, adjusters and providers offering excellent customer service by responding to and answering their questions quickly and professionally

Pay & Benefits :

Requirements

Physical Requirements :

Candidate must be able to sit the majority of an 8-hour day except for lunch and break times. Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPAA compliant.