What are the responsibilities and job description for the Provider Contact Center Specialist position at PrimeWest Health?
Join a team that makes a difference! PrimeWest Health is seeking a detail-oriented and customer-focused professional to be the voice of our Provider Contact Center. In this role, you'll be the first point of contact for healthcare providers, helping resolve questions about claims, authorizations, eligibility, and more.
If you thrive in a fast-paced environment, enjoy problem-solving, and are passionate about delivering exceptional service, we’d love to hear from you!
- Competitive benefits
- Professional growth opportunities
- A supportive team environment
Educational Requirements and Qualifications
- Associate degree or two or more years of experience in medical claims required
- Proficiency in Microsoft Office applications
- Strong organizational skills with the ability to manage multiple tasks
- Excellent verbal and written communication skills
- Ability to work collaboratively with diverse individuals and teams
- Physical ability to sit or stand at a workstation for extended periods; occasional lifting of items up to 20 pounds
- Some travel may be required
Role and Key Responsibilities
Provider Contact Center Support
Assist the Provider Contact Center Manager and PrimeWest Health staff with the following:
- Respond to inbound provider calls regarding eligibility, claims, authorizations, and program-related inquiries
- Make outbound calls to follow up on provider issues and offer education when claim processing concerns are identified
- Ensure timely and accurate responses to all provider inquiries
- Stay current on DHS/CMS requirements, PrimeWest Health Provider Manual updates, and provider communications
- Verify the accuracy of information provided to members and providers
- Escalate unresolved issues to the Provider Contact Center Coordinator or Manager and route calls appropriately
- Notify management of recurring issues that result in repeat calls
- Support customer service excellence by performing additional duties as assigned by the Provider Contact Center & Claims Examination Manager
- Assist with provider web portal registration as needed
- Identify and report system processing issues to the appropriate teams
Communication
- Maintain positive, professional, and productive communication with all internal and external customers
General Work Requirements
- Uphold a professional image with coworkers and customers
- Work overtime as needed
Professional Competencies
- Call center experience preferred
- Strong understanding of healthcare claim data sets and electronic claim forms
- Familiarity with Medicare and Medical Assistance reimbursement methodologies, including hospital and physician payment models
- Ability to navigate CMS, DHS, and healthcare-related websites efficiently
- Detail-oriented, self-motivated, and able to work independently