Provider Call Center Representative (Day shift)

Ontario, CA 91761

Posted: 10/01/2019 Job Category: Admin/Clerical Job Number: 1861752
Provider Call Center Representative
Kinetic Personnel Group is currently recruiting for a Provider Call Center Representative for a public health agency in the Ontario area. This multi-billion-dollar nonprofit is renowned for its work in the community and being a great place to work.
Job Duties:
The Provider Call Center Representative is responsible for responding to Provider calls in a friendly, professional manner. The Provider Call Center Representative must be able to utilize all policies and resources to answer questions and direct Providers in order to resolve their concerns.
  • Act as a Provider Advocate.
  • Communicate with contracted and non-contracted Providers by providing information and assistance as appropriate.
  • Handle claim status inquiries, researching and facilitating resolution of payment issues; provider education on remittance advice interpretation and reimbursement, and informing providers of the claims appeals process.
  • Assist Providers with interpreting Member eligibility and benefit information
  • Successful completion of 6-week Provider Call Center training,
  • Active participation in continuous training,
  • Follow required call scripts and QA requirements.
  • Handle an average of 65 inbound/outbound calls per day.
  • Strict adherence to specific work schedule and company attendance and punctuality policy.
  • Maintain standards for Provider and Member Rights and Responsibilities, such as maintaining Provider and Member confidentiality.
  • Document timely and accurate of all calls received. Over 100% call documentation is required
Job Requirements:
  • High School Diploma or GED
  • 1 year of Healthcare Call Center experience
    • Or 2 years of Call Center experience (any industry) with 2 years of healthcare industry experience
  • Basic MS Office/computer skills
  • Excellent customer service and communication verbal/written skills preferred
  • Knowledge of Medicare and / or Medi-CAL preferred
  • Must pass a criminal background check and drug test per healthcare federal and state regulations
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