Provider Relations Rep I (Remote, $15/hr)

American Specialty Health Incorporated is seeking a Provider Relations Representative I to join our Provider Relations (PRL) department. This position will respond to practitioner inquiries via the telephone queue system regarding credentialing, re-credentialing, and contracting to ensure efficient and effective resolution of practitioner inquiries or complaints and to deliver high quality customer service. Additional duties will include other administrative tasks related to credentialing, re-credentialing, and contracting as assigned.

Remote Worker Considerations:

Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed).  

Responsibilities

• Respond to and resolve practitioner inquiries received via the Provider Relations and Credentialing queue.
• Answers incoming calls in a professional, accurate, timely and courteous manner from the Provider Relations and Credentialing queue.
• Assists practitioners, staff, and clients with questions regarding credentialing, re-credentialing, participation requirements, contractual issues, and high-level administrative problems.
• Performs credentialing and re-credentialing activities according to plan specifications.
• Forwards complex requests that require research to the appropriate ASHCore bucket or PRL supervisor to achieve appropriate resolution.
• Captures practitioner complaints and resolves or forwards to the appropriate ASHCore bucket or PRL supervisor for resolution.
• Captures practitioner change information, documents, and forwards as required to record changes in appropriate databases.
• Manages necessary administrative duties to properly support, document and resolve practitioner inquires.
• Maintains confidentiality of practitioner files, participation data, practitioner records/documents and all discussions relative to recruiting, contracting, and credentialing processes.
• Attends department and all-staff meetings to increase knowledge and foster teamwork.
• Complete administrative tasks assigned.
• Pull CAQH applications when provider calls in with CAQH number. Drop application in designated folder.
• Download CAQH applications for PTOT practitioners that are being added to a provider.

Qualifications

• Associates degree or equivalent preferred. If equivalent experience, high school diploma or GED required.
• Minimum 2 years of progressive experience performing customer service duties preferred.
• Specialty health care or health care experience preferred.
• Credentialing and re-credentialing experience preferred.
• Proficient in MS Office with experience in word processing and spreadsheet applications.
• General understanding of Provider Relations Guidelines.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

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