Summary

Under the Provider Network Operations (PNO) Provider Network Management Supervisor's general direction, the PNO Provider Support Representative is responsible for responding to all PNO department queue incoming calls in a courteous and efficient manner, and triaging Client IPA, Provider and Provider office staff telephone inquiries. Provides first class customer service and ensures that all necessary data is collected/completed properly, accurately, and thoroughly. The PNO Provider Support Representative provides customer satisfaction to both internal and external personnel and strives to continuously improve service delivery.

Duties and Responsibilities

· Records and maintains complete and accurate records of provider communications regarding member service provision according to department documentation requirements

· Works with provider and provider office staff to resolve, triage, or escalate questions concerning provider completion of delegated and contractual duties

· Respond appropriately within skill level and documented departmental policies and when appropriate, seeks department leadership advice when responding to complex phone inquiries

· Follow through in a timely manner on urgent provider requests

· Provides detailed explanation to client, provider and/or provider office staff regarding IPA and provider status and database setup

· Informs Supervisor and Department leadership when potential provider problem is communicated by member regarding provider-member relationship or regarding member concern with care rendered

· Provide exceptional customer service to ensure both Client IPA and contracted provider satisfaction with the IPA

· Assist in various mandatory projects such as provider outreach, compliance requirements, data cleanup, workflow revisions, upkeep of maintenance and other projects as assigned

· Foster open lines of communication with Leadership on any network changes or issues

· Understand and follow the Employee Handbook policies and procedures

· Ensure HIPAA compliance is always observed/performed

· Perform other duties/assignments as needed

Minimum Job Requirements

· High School Diploma or GED required, Bachelor’s degree in healthcare, human services or related field preferred

· 1 years Managed Care or Healthcare experience in Network Management, a plus

· Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

· EZ-CAP knowledge, a plus

Skills and Abilities

· Strong communication skills, including both oral and written

· Ability to maintain multiple priorities and deadlines, with strong follow through

· Highly motivated with excellent attention to detail

· Ability to work independently and take direction

· Ability to quickly learn and use new software tools

· Demonstrate commitment to the organization’s core values

· Ability to provide and receive constructive job-related feedback