Job Description
Provider Relations Representative_ Temporary Position
SEE how you can make a difference! Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.
Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family.
Scope and Purpose of Position
The Provider Relations Representative is an experienced customer service professional with excellent interpersonal, verbal and written communication skills. The Provider Relations Representative serves as the first point of contact for Superior Vision’s provider network. This individual will have the skill set to analyze and problem solve any claims-related issues and make system updates to provider demographic information as needed. This individual must have excellent organizational skills and be able to multi-task. The Provider Relations Representative will assist the Provider Relations Managers with network recruitment activities and provider network updates. He or she will prepare documents for Credentialing, as well as, review and monitor provider complaints, grievances, and escalated issues as necessary to the appropriate staff.
Essential Functions
• Serve as initial contact and respond to all provider related inquiries with exceptional service and timely responses in a professional and courteous manner
• Resolve and respond to provider claims issues and complaints:
• Identify and correct fee schedule issues
• Submit requests for adjustments to Claims
• Provide education to providers and their office staff regarding processes and changes
• Accurately update systems with changes in provider information
• Process recruitment materials and applications received from providers
• Assist in recruitment projects, network comparisons and data entry
• Initiate improvements to processes and procedures for Provider Relations that support company and departmental standards and strategic directives
• Perform other related duties as assigned
Education & Experience
• High school diploma or equivalent is required. Associates Degree is preferred
• Requires three (3) or more years of Customer Service and administrative experience.
• Previous health care experience in a managed health care environment (including Medicare / Medicaid), provider relations or customer service, including working with members and providers is preferred. Understanding of vision care insurance is a plus
HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, age, sex (including pregnancy), sexual orientation, gender identity or expression (including transgender status), national origin, ancestry, status as a protected veteran or disabled veteran, physical or mental disability or history of disability, genetic information, marital status, or any and all other categories protected by under applicable Federal, state or local law.
This policy extends to all associates and to all aspects of the employment relationship. Any associate who violates this policy will be subject to disciplinary action up to and including termination.
