Provider Service Representative

Job Description

Job Description

Benefits:

• 401(k)
• 401(k) matching
• Company parties
• Competitive salary
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

About the job

Company Description
Health Network Solutions (HNS) is a clinically integrated chiropractic physician network dedicated to improving healthcare access, effectiveness, and affordability. By partnering with payors, employers, and healthcare professionals, HNS delivers innovative services through unique quality initiatives, efficient electronic solutions, and cost-saving administrative support. Located in the Charlotte Metro region, HNS is committed to providing its clients with exceptional service and evidence-based healthcare solutions. The companys dedicated team strives to enhance patient health outcomes while reducing overall costs.

Position Overview
This is a full-time, on-site role for a Provider Service Representative at HNS in the Charlotte Metro area. The responsibilities of the Provider Service Representative include assisting healthcare providers with daily inquiries, resolving issues related to the network and claims, delivering exceptional customer service, and maintaining positive provider relationships. The role also involves monitoring and ensuring compliance with HNS policies and guidelines and providing education and support to providers as required.

Position Description

• Serve as primary point of contact and liaison between HNS, its network providers, and managed care partners.
• Receive and respond to provider inquiries and complaints. Provide detailed responses which educate providers on HNS, and its managed care partners, policies and procedures on network participation and claims.
• Research, analyze, and identify appropriate resolution for provider inquiries regarding claims submission, processing, and payment-related issues.
• Use pertinent policies and procedures, data, and facts to provide resolution for non-standard requests and issues.
• Provide training and ongoing education to enable network providers to become more self-sufficient; especially in functions that negatively impact payment if not performed with a high degree of specificity, for example, eligibility confirmation and claims submission.
• Upon receipt of notification, initiate appropriate modification of provider-related information, including changes in demographic and contact information, and practice location.
• Recommend policy and procedure revisions to improve provider satisfaction.
• Maintain detailed documentation of all communication with network providers and managed care partners.

Required Qualifications:

• Bachelors degree in healthcare related field or equivalent experience.
• 3+ years of experience in provider relations or managed care claims customer service environment
• Experience with claims and EOBs
• Excellent communication skills (written and verbal)
• Detail-oriented and highly proficient at problem solving
• Highly organized, excellent time management and prioritization skills
• Proficiency with Microsoft Office (Word, Excel, Outlook)

Preferred Qualifications:

• Intermediate level of proficiency in provider issue resolution
• Intermediate level of experience with claims and EOBs
• Prior experience billing insurance a chiropractic or other medical office
• 5-10 years of experience