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USA

Provider Experience Center Representative

Mesa - Arizona (AZ), 85201

Banner Health

Job Description:

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Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care – and the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

Our Provider Experience Center is responsible for servicing all BHN and NPA providers. We handle several lines of business including United Healthcare Medicare Advantage and BCBS Medicare Advantage provider inquiries. This position will take call inquiries related to claims, prior auth, credentialing, contracting and web portal inquiries for our provider population.

In this role, the PEC Rep provides inbound/outbound expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. They may also be assigned to work in a variety of administrative duties relative to supporting the provider community.

Shift Schedule: M-F, 8am - 4:30pm

This position has the ability to move to remote work after 6 months based on proficiency and job knowledge.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

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About Banner Health Network & Banner Plan Administration
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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    Job Summary

    This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. May be assigned to work in a variety of administrative duties relative to supporting the provider community.

    Essential Functions
  • Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.)

  • Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the departments ongoing goals and objectives.

  • Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians office staff.

  • Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms.

  • Assists internal departments in resolving provider appeals pertaining to the organizations physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organizations insurance plan administration staff.

  • Works on special projects as assigned.

  • Minimum Qualifications

    High school diploma/GED or equivalent working knowledge.

    Must have substantial previous related work experience in healthcare services, with three to four years of experience in a high volume service center or managed care environment. Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at all times.

    Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills. Must have the ability to acquire and utilize a sound knowledge of the companys provider information systems, as well as, fundamental knowledge of the organizations expectations. Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall provider experience.

    Preferred Qualifications

    Experience with a strong knowledge of business and/or healthcare as normally obtained through the completion of an associates degree. The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology.

    Additional related education and/or experience preferred.

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