Provider Service Advocate
Independent Living Systems
Suffolk, FL
4d ago

POSITION SUMMARY

The Provider Services Advocate is responsible for responding to Provider telephone inquiries and for identification and elevation of issues to management.

REQUIREMENTS FOR ALL POSITIONS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools or controls.

The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl.

The employee must occasionally lift and / or move up to 25 pounds, and infrequently up to 50 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.

The noise level in the work environment is usually moderate.

POSITION RESPONSIBILITIES AND ACCOUNTABILITY

  • Provide world class service to our providers by responding to provider issues and inquiries that are received via the telephone.
  • Review, research and respond to inquiries from Providers.
  • Identify issues based on provider inquiries and elevate those issues management.
  • Analyze database to identify problems / issues pertaining to claim processing.
  • Document computer system to track inquiry.
  • Meet departmental statistical world class goals
  • Complete claim adjustments and / or claim processing upon request.
  • Complete miscellaneous assignments upon request.
  • Maintain production and quality scores as follows :
  • STANDARD CALLS QUALITY %

    Unacceptable

    STANDARD CALLS PER HOUR

    OVER 6 MOS.

    POSITION QUALIFICATION

  • High School Diploma / GED required; college course work preferred.
  • Experience processing UB04 and CMS 1500 claims
  • Self-starter, conscientious, independent worker.
  • Strong knowledge of Customer Service skills and techniques required.
  • Excellent written, verbal and grammatical communication skills required.
  • Ability to read, interpret, analyze technical / business procedures and / or governmental regulations required.
  • Ability to write reports, business correspondence and procedural manuals required.
  • Knowledge of automated systems (technical adeptness) required.
  • Demonstrated proficiency in Microsoft programs (ie, Excel, Word, PowerPoint) required; knowledge of Microsoft Access preferred.
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