Provider Relations Representative I

American Specialty Health Incorporated (ASH) is seeking a Provider Relations Representative to join our Provider Relations department.

The primary purpose of this position is to respond to practitioner inquires via the telephone queue system regarding credentialing, re-credentialing and contracting to ensure efficient and effective resolution of practitioner inquires 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.

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Remote Worker Guidelines

• Remote Worker Guidelines: 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 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 50 Mbps download and 50 Mbps upload speed.)

Responsibilities

• Respond to and resolve practitioner inquiries received via 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.
  • Handles 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

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Qualifications

• High School Diploma or GED certificate required.
• 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.