Provider Services Representative

Found in: Appcast Linkedin GBL C2 - 2 weeks ago

Plymouth, United States Fulcrum Health, Inc. Full time

Fulcrum Health, Inc. is a nonprofit, physical medicine benefit management organization that has delivered quality care through its network of over 2,800 licensed and credentialed chiropractic and acupuncture service providers for almost 40 years. Our product offerings include acupuncture and chiropractic pain management services, and we serve over 2 million health plan members within the Upper Midwest, Fulcrum continues to offer innovative and inspiring ways to leverage physical medicine that help lower health care costs, achieve better outcomes, and increase patient satisfaction.


The Provider Services Representative is a critical member of Fulcrum’s Network Management team. The position functions as a liaison between providers, the organization, and its customers. Responsibilities include communicating with and maintaining strong relationships with Fulcrum’s network providers and provider clinic staff. Intake, research, respond to, and track and report on external and internal inquiries. Maintains current knowledge of and complies with policy, procedures and regulatory requirements in the organization, as well as regulatory and customer requirements for day-to-day activities and projects. Additionally, this role will develop and maintain provider educational materials, assist with provider training, provider onboarding, research and respond to claim inquiries, support network expansion efforts, and participate in quality improvement activities. This is a hybrid position requiring an on-site presence at our Plymouth, MN, office two to three days a week. Only local candidates will be considered for this role.


ESSENTIAL FUNCTIONS:

  • Initiate and maintain effective channels of communication with network providers, and provider office staff
  • Handle provider, provider office staff and Fulcrum client inbound inquiries within expected turnaround times
  • Assist providers and provider office staff with problem resolution
  • Research and respond to claims inquiries
  • Gather, review, and submit relevant documentation needed to resolve claim inquires
  • Conduct outreach to providers
  • Develop and maintain education materials (i.e. FAQ’s)
  • Coordinate publication of provider materials on Fulcrum portals (i.e., administrative procedure tools, provider manual, provider billing training, etc.)
  • Initiate and participate in process improvement opportunities
  • Compile routine inbound and outbound inquiry statistics (key performance indicator)
  • Develop and maintain policies and procedures
  • Document and maintain work instructions
  • Support network expansion efforts
  • Other duties as assigned.


REQUIRED QUALIFICATIONS: (Minimum qualifications needed for this position)

  • Experience in customer services, client services, provider relations, or claims processing
  • 3+ years of experience in coordinating and managing administrative business processes
  • Project management skills
  • Effectively prioritize and execute tasks
  • Strong attention to detail
  • Customer service skills
  • Strong verbal and written communication skills
  • Critical thinking, analysis and problem solving
  • Ability to maintain composure in stressful situations
  • Project a professional business presence and appearance
  • Knowledge and experience with MS Office suite and applications (i.e. Excel, Word, TEAMS, and Outlook)


PREFERRED QUALIFICATIONS:

  • Bachelor's degree or equivalent industry experience
  • Experience with Zendesk and/or other client relationship management (CRM) solutions
  • Experience with Symplr sProvider

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