Provider Services Representative

Provider Services Representative

Since 1983, our mission has been to be the workers compensation partner of choice for agents, employers and their workers. We are unique in that we are small enough that your voice is heard, but have all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers. We are an employee centric organization, and we believe that your success is our success. Benefits include a flexible work environment, health / dental insurance that includes supplemented dependent care coverage, generous PTO, student loan payback, a bonus program, 401k with match and much more!! Being able to work in a collaborative environment is key to being successful at SFM. We believe that our exceptional and motivated employees are our greatest strength, and we are committed to creating the best work environment. Apply today and discover why SFM employees choose to stay!! Our benefits include : Affordable Medical, Dental, Vision Insurance, HSA, FSA Traditional and Roth 401(k) plans with company match Company contributions to help pay off student loans Monthly home internet allowance Free life insurance, STD & LTD Opportunities for annual gainshare bonus Pet insurance Generous PTO 9 paid holidays Paid parental leave Annual company-wide volunteer day Adoption financial assistance

The Role

Provider Service Representatives work in a team driven environment in our Insurance Operations Department. This role has a variety of tasks which includes requesting records, monitoring those requests and working with a multitude of provider / vendor relationships and analyzing documentation for the retention and or retrieval of documents in accordance with established best practices and procedures. You will play a vital role in the management of workers compensation claims and be part of SFMs goal, which is focused on delivering unrivaled customer service seeking positive outcomes for employers and injured workers. If you thrive in an environment that gives you lots of variety, than this position may fit your professional goals.

What you will be doing :

• Requests records as instructed by customer for the purpose of investigating a claim or legal file using various methods (fax, email, US Mail, Vendor portal, etc.); records include, but are not limited to, medical records, diagnostic films, employment files, wage records, insurance files, Social Security records, records from State Departments, etc.
• Monitors the record requests, verifies acceptability of documents received, and ensures records are received timely and organizes the documents in a presentable fashion for the customer.
• Works with providing guidance concerning SFMs billing practices and acts as a resource for providers concerning bills submitted for payment while looking for efficiencies improving e-billing opportunities and troubleshooting areas of discrepancy concerning bills submitted for payment and created documentation as needed.
• Oversees end to end process of media from point of receipt, notification to appropriate parties, record and maintain according to company prescribed document retention and destruction processes.
• Handles complex matters and deals with escalated situations and issues with limited supervision.
• Reviews, authorizes, submits, and reconciles invoices for requested records using State specific regulations, internal policies and guidelines as well analyzing, troubleshooting and responding to inquiries related to duplicate payments and pursues active reconciliation to include recovery of funds as needed.
• Manages various monthly and quarterly reports pertaining to the vendor and provider table and its information integrity.
• Follows State and Federal regulations, as well as comply with HIPPA requirements, internal policies and guidelines while requesting confidential information and records.
• Maintains provider internal database of Release of Information (ROI) departments for future requests utilizing claims management system.
• Supervises a multitude of provider / vendor relationships to analyze, interpret, enter, retrieve, and modify documentation in accordance with established best practices and procedures.
• Performs research, when necessary, to identify proper location to request records from and takes initiative to locate missing information and catalogs in relating vendor and provider tables within claims management system.
• Maintains timely and accurate processing, research, and clearance of workflow queues and identifies and assesses customer needs to achieve satisfaction and to ensure team is producing and completing work as per Insurance Operations Partnership Agreement.
• Seeks out ways to improve team and process efficiencies and identify problems, while offering solutions and resolving issues promptly within the scope of authority and shares those ideas with Sr. Leadership.
• Provides training and mentorship to others when needed.