Job Description

JOB SUMMARY

A Senior Provider Concierge exemplifies advanced knowledge of provider relations and plan operations with a strong claims knowledge base and understanding of plan benefits, conveys excellent customer service skills with advanced conflict handling and communication relevant provider relations experience, preferably with Medicare and specifically with Medicare Advantage programs, and familiar with PPO’s and HMOs. Must have strong oral and written communication skills, planning and problem-solving skills, and be skilled in personal diplomacy. The applicant must possess a high level of motivation, professionalism, and ethical conduct and place a premium on treating others with dignity and respect. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Receive all inbound calls from the provider population and conduct proactive outbound calls as assigned
• Address provider concerns and answer questions related to claims inquiries (including disputes and appeals), provider resources, and service issues
• Resolution and timely response to all provider problems within expected or required timeframes
• Adhere by all set provider services call center metrics and call evaluation requirements including, but not limited to set monthly call volume, average speed of answer, average handle time and missed/refused call volume.
• Assist with responding to provider inquiries via email, as well as monitoring the departments incoming tickets for resolution.
• Complete all new provider onboarding, in the timeline required.
• Maintain quarterly, targeted outreach and visits as identified to assigned practices, facilities, and ancillary providers.
• Maintain completion of special projects, as assigned. This includes but is not limited to targeted provider education/outreach, timely ticket submission, monitoring, and auditing, etc.
• Assume ownership and responsibility for provider satisfaction with HealthTeam Advantage to ensure retention and loyalty.
• Assist with contracting and credentialing efforts as requested including, but not limited to Provider Oversight Committee agenda, outreach for signatures, obtain missing documentation, etc.
• Provide education on access to services and resources such as the website, provider portal, provider manual, prior authorization list, Acuity portal, etc.
• Prepare monthly newsletter articles for the Plan’s Provider Connection newsletter.
• Provide education on claims payment policies, CMS claims processing policies, etc.
• Multi-departmental support as needed with Appeals and Grievances, Claims, Quality/RAF, Compliance, Enrollment and Member Services.
• Ability to work before/past normal shift hours to complete any outstanding tasks for a provider.
• All other duties as assigned

EDUCATION AND EXPERIENCE

Education:

• High School diploma, GED, or equivalent work experience.

Required Experience:

• 12 months experience in Call Center/ High call volume handling experience
• Claims Experience
• Provider Relations experience
• Customer service, sales, or account management experience
• Managed care or health plan operations experience

Preferred Experience:

• Medicare experience

Other Requirements:

• Annual Flu Vaccine
• COVID-19 Vaccine

KNOWLEDGE, SKILLS, AND ABILITIES

Required Competencies:

• Professional and institutional claims knowledge
• Excellent problem solving and organizational skills
• Strong interpersonal communication skills
• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Ability to work independently or as a team
• Operate general office equipment, including but not limited to computer, phones, and related devices
• Reliable and insured transportation for onsite physician onboarding
• Testing/Competency

Preferred Competencies:

• Thorough knowledge of CMS guidelines, process, and systems

PHYSICAL REQUIREMENTS

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or;
• A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

ABOUT HEALTHTEAM ADVANTAGE

HEALTHTEAM ADVANTAGE is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company, offers Medicare Advantage plans to eligible Medicare beneficiaries in 11 North Carolina counties. HTA has been named a “Best Places to Work” finalist three times by Triad Business Journal. To learn more, visit HealthTeamAdvantage.com.  

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