Provider Relations Specialist
New
J
JobgetherHealthcare
USFull-Time
Salary14 - 23.42 USD per hour
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Job Details
- Required Skills
- Microsoft ExcelCustomer service
Requirements
- Associate degree preferred, or comparable experience in workers’ compensation or a related field.
- Working knowledge of applicable state workers’ compensation regulations.
- Strong knowledge of fee schedules and network contracts.
- CPC certification preferred.
- Expert-level medical bill review analysis experience preferred.
- Strong customer service experience with the ability to handle routine and complex provider inquiries professionally.
- Excellent verbal and written communication skills.
- Strong organizational and time-management abilities with excellent attention to detail.
- Excellent interpersonal skills and the ability to build productive relationships.
- Proficiency with Microsoft Office applications, particularly Word and Excel.
- Ability to independently research, interpret, and explain billing information accurately.
- Strong problem-solving and analytical skills.
Responsibilities
- Communicate clearly, professionally, and efficiently with providers and other stakeholders through phone and email.
- Assist providers with bill review questions and requests of varying complexity, ensuring accurate and timely resolutions.
- Apply workers’ compensation guidelines and client-specific contract language when interpreting and explaining medical bill review outcomes.
- Navigate bill review applications and related systems to retrieve accurate information and respond effectively to provider inquiries.
- Interpret explanations of review (EORs) and account for client-specific billing requirements and nuances.
- Answer basic to complex questions regarding state workers’ compensation fee schedules and billing requirements for processed medical bills.
- Support inquiries involving both regular and facility medical bill types.
- Explain provider contracted rates, network agreements, and carve-outs applied to medical bills in a clear and professional manner.
- Identify and document bill review errors and trends to support quality improvement and help reduce team error rates.
- Manage phone conversations effectively to promote timely resolution and minimize provider hold times.
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