Previous Job
Senior Customer Service Representative
Ref No.: 18-11885
Location: Phoenix, Arizona
Start Date / End Date: 10/01/2018 to 09/30/2019

Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Maintain and enhance relationships with facilities, physicians and ancillary providers which serve as contractual networks of care for members
  • Establish/maintain and align contracted provider demographic data and negotiated reimbursement arrangements across provider systems
  • Review new and existing contract reimbursement arrangements for compliance with standards and determine most appropriate system input methodology that facilitates accurate and consistent claim adjudication
  • Maintain cooperative working relationships with internal Healthcare contacts
  • Analyze, identify and report on significant changes to network configuration and market information
  • Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
  • Extract information from provider systems to meet business reporting needs
  • Performs credentialing support activities as needed.
  • Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
  • May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
  • Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
  • May provide guidance and training to less experienced team members.

Background/Experience Desired
Track record of prioritizing work, multi-tasking, and managing workload efficiently.

Education and Certification Requirements
College degree or equivalent work experience preferred.

Additional Information (situational competencies, skills, work location requirements, etc.)
Possesses a working knowledge of Intuit Quick base, MS Excel, Outlook, Word a plus
Knowledge of managed care business and healthcare environment a plus