Provider Relations Representative

2 days ago

Salem, United States PacificSource Full time
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Maintain positive public relations with provider groups, hospitals and clinic administrators across all business lines. Act as a personal contact for training, materials distribution, and as an information resource. Work throughout the PacificSource service area to educate provider office staff on current coding and PacificSource administrative and claims procedures. Act as a leading resource for cross functional, complex problem-solving within the Provider Network Department.

Essential Responsibilities:
  • Visit provider groups for on-site service calls to update office staff on PacificSource products, administrative and claims procedures, and current coding issues pertaining to all business lines.
  • Visit newly contracted providers within eight weeks of contract implementation.
  • Work to resolve potential problems before they become an issue with the provider groups and work to ensure satisfaction with PacificSource.
  • Distribute a variety of claims analysis reports and other information pertaining to the provider's practice.
  • Provide follow-up on behalf of Customer Service and other PacificSource departments regarding participating providers' contract questions or compliance issues across all business lines.
  • Act as a liaison for PacificSource between provider groups, PacificSource members, and PacificSource to resolve problems and comply with requests.
  • Communicate with provider offices and their staffs, PacificSource departments, PacificSource Special Investigations Unit, and Provider Network Contract Account Lead.
  • Document problems, issues, and resolution in provider files or call tracking as needed.
  • Help ensure maintenance and accuracy of the Provider Manual.
  • Thoroughly explain the Provider Manual, provider contract, member plan information, and other information during on-site service calls and as needed, drawing on extensive knowledge of materials and policies.
  • Review documents before delivery to ensure accuracy.
  • May assemble materials and other collateral information prior to delivery.
  • Demonstrate proficiency in performing provider education and introductory meetings and presentations, including PacificSource mission and business, InTouch functionality and registration, claims procedures, administrative procedures, member plan information, provider networks, and how to access appropriate forms and information on the PacificSource website as well as contacting appropriate PacificSource representatives for assistance.
  • Prepare materials and presentations for the meetings. Ensure providers are well informed around new policies, changes, and general updates.
  • Provide education both in person and on the phone about InTouch functionality and troubleshooting.
  • Prepare and maintain provider service files.
  • Assist in the maintenance of provider demographics and serve as a resource to internal personal and provider office staff regarding participating provider maintenance.
  • Perform operational tasks related to participating provider set-up and take necessary action to assure accurate internal implementation.
  • Participate in the publication and mailing of the quarterly provider newsletters by gathering information and writing articles.
  • Speak as a PacificSource representative at provider-related functions.
  • Attend provider-related conferences as a vendor in order to distribute information, network, and answer questions about PacificSource.
  • Place supply orders and update inventory of PacificSource logo give-away products.
  • Anticipate in local medical organizations such as Medical Assistants Organization and local chapters of the American Academy of Professional Coders (AAPC). Develop positive working relationships with provider groups and their staff to assure that providers' concerns are addressed by the appropriate person(s) in a timely, responsive manner.
  • Provide prompt, professional, and courteous service to providers, members, and PacificSource employees.
  • Engage in intradepartmental projects and be able to participate knowledgeably and collaboratively to ensure success for department initiatives.
  • If necessary, act as the sole departmental representative on cross-departmental initiatives, with broad, effective knowledge of all aspects of departmental functions.
  • As needed and consistent with proficiency and experience, participate in elements of training for employees who are new to the department.
  • Able to confidently interact with all levels of management at PacificSource, on an as-needed basis.
Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.
Work Experience: A minimum of 2 years of PacificSource experience as a Provider Service Specialist or a combination of Provider Service Specialist and another internal position or 3 years of external experience in related healthcare field.

Education, Certificates, Licenses: High school diploma or equivalent required. BS or BA in business or healthcare administration preferred. A CPC or CPC-P certification is helpful.

Knowledge: Excellent written and oral communication, including diplomacy skills for working with the medical professional community as well as the members enrolled in a PacificSource plan. Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Ability to read, understand and communicate PacificSource policy. Effective problem solving skills. Ability to read, understand, and communicate provider contractual agreements. Medical terminology proficiency. Experience or education in ICD-10-CM and coding. General computer, word processing and spreadsheet skills. General clerical skills. Ability to remain current on PacificSource administrative and claims procedures, healthcare and the health insurance industry, and claims coding issues. Excellent public relations skills. Ability to prioritize work. Current driver's license. Travel throughout the state, generally by automobile, with some overnight visits required.

Competencies:

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time or as needed to complete minimum requirements for site visits, workshops, and provider education.

Skills:
Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.


Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

  • Client Relations Specialist

    2 weeks ago

    Salem, Oregon, United States FastSigns Full time

    Position Overview:FASTSIGNS is seeking a dedicated Customer Service Representative to enhance our client relations.Benefits and Perks:Competitive CompensationPaid Time Off and HolidaysPerformance-Based BonusesContinuous Training and DevelopmentKey Responsibilities:The Customer Service Representative will:Act as the primary point of contact for both existing...

  • Guest Relations Specialist

    1 week ago

    Salem, Massachusetts, United States The Cove Full time

    Job Title: Guest Relations Specialist at The Cove Hotel Location: Salem, MA JOB SUMMARY We are in search of an enthusiastic Guest Relations Specialist to represent warmth and hospitality at The Cove Hotel. This position transcends standard front desk responsibilities; it focuses on crafting extraordinary guest experiences and ensuring that every visit is...

  • Director of Stewardship and Donor Relations

    1 month ago

    Salem, United States Roanoke College Full time

    Job DescriptionJob DescriptionThe Director of Stewardship & Donor Relations provides strategic leadership within the Advancement Division for donor stewardship, donor recognition and special events for the College.The Director is responsible for producing, managing and consulting for logistical aspects of college-wide, alumni, and/or development special...

  • Client Relations Specialist

    2 weeks ago

    Salem, Virginia, United States Carter Machinery Full time

    Carter Machinery Company, a leading authorized dealer for Caterpillar, is seeking a Customer Support Representative to join our dynamic team. This role is pivotal in providing exceptional telephone and field product sales support, aiming to identify and cultivate new business opportunities within our parts, service, and rental sectors. The successful...

  • Client Relations Specialist

    1 week ago

    Salem, Virginia, United States FastSigns Full time

    FASTSIGNS #30502 is seeking a dedicated Customer Service Representative to enhance our customer engagement efforts. Benefits and Advantages: Attractive CompensationPaid Time Off and HolidaysContinuous Training and DevelopmentKey Responsibilities of a FASTSIGNS Customer Service Representative:Act as the primary point of contact for both existing and potential...

  • Assistant Director of Alumni

    1 month ago

    Salem, United States Roanoke College Full time

    Job DescriptionJob DescriptionDesign, organize and facilitate alumni, family, and volunteer involvement in Roanoke College activities, programs, and projects for the enhancement of the mission of Roanoke College and with a focus on fundraising outcomes. Key Responsibilities:In conjunction with supervisor, develop annual strategic and tactical plans that...

  • Customer Service Representative

    1 week ago

    Salem, United States VESTIS Full time

    Handle inbound customer calls and provide requested information on all available items, pricing, and service of the customer's account. Efficiently and accurately record all information including any notes related to the customer's issue or account. Customer Service Representative, Customer Service, Representative, Manufacturing, Retail, Skills

  • Client Relations Specialist

    2 weeks ago

    Salem, Virginia, United States Carter Machinery Full time

    Carter Machinery Company, the authorized dealer for Caterpillar in the region, is seeking a Customer Support Representative to join our dedicated team. This role is pivotal in providing exceptional telephone and field support for product sales, aiming to identify and cultivate new business opportunities in parts, service, and equipment rentals for designated...

  • Client Relations Specialist

    2 weeks ago

    Salem, Virginia, United States Carter Machinery Full time

    Carter Machinery Company, the authorized dealer for Caterpillar, is seeking a Customer Support Representative to join our team. This role is pivotal in providing both telephone and field support for product sales, aimed at identifying and pursuing new business opportunities to enhance our parts, service, and rental operations with designated accounts.The...

  • Emergency Care Physician Assistant

    2 weeks ago

    Salem, Oregon, United States Provider Healthcare Full time

    Position Type: Full Time Compensation: $130,000 - $170,000 Patient Load: 20-22 patients per day Electronic Medical Record System: Epic Work Environment: All age groups; Emergency Care Position ID: 60747 Position Overview:A client based in Oregon is in search of a Physician Assistant to deliver medical services to patients across all age demographics in an...

  • Retail Sales Representative

    2 months ago

    Salem, United States Verizon Full time

    Verizon - Immediate Retail Sales Representative NeededDo you enjoy creating a delightful shopping experience for customers? Are you skilled in upselling and cross-selling products? If yes, then you might be the perfect fit for our dynamic team at Verizon!Verizon is a leader in the cellular and home connectivity industry, dedicated to providing exceptional...

  • Customer Support Representative

    4 months ago

    Salem, United States PacificSource Full time

    Provide excellent customer service primarily by telephone to all PacificSource customers. Assist customers with coverage/claims related questions. Accurately interpret benefits and policy provisions for all PacificSource products. Conduct appropriate Support, Representative, Customer Service, Healthcare, Retail, Customer, Building

  • Hospice Nurse

    1 month ago

    Salem, United States Provider Healthcare Full time

    Job Type – Full Time Patients Per Day – 10-12 EMR System - Epic Work Location – Hospice/Palliative Care Job Description A Salem based client is searching for an experienced Registered Nurse to provide excellent nursing care in a hospice and palliative in-home setting. An ideal candidate is a team player, detail-oriented, has geriatrics experience,...

  • Hospice Nurse

    3 hours ago

    Salem, United States Provider Healthcare Full time

    Job Type Full Time Patients Per Day 10-12 EMR System - Epic Work Location Hospice/Palliative Care Job Description A Salem based client is searching for an experienced Registered Nurse to provide excellent nursing care in a hospice and palliative in-home setting. An ideal candidate is a team player, detail-oriented, has geriatrics experience, monitor and...

  • Customer Service Representative

    3 months ago

    Salem, United States Aramark Uniform Services Full time

    ** Customer Service Representative** **Job Category****:** Service-Customer Service **Requisition Number****:** CUSTO13504 Showing 1 location **Job Details** **Description** **Aramark is Currently Hiring for a Customer Service Representative in Salem, VA** This Customer Service Representative position is responsible for providing exceptional service to...

  • Construction Representative

    4 weeks ago

    Salem, United States Alfred Benesch & Co. Full time

    Simply Put, A Great Place to Work Benesch is a growing, multi-disciplined planning, engineering, and professional services firm. We enhance infrastructure and communities across the country - creating spaces and providing connections in ways that make a difference. We pride ourselves on being nimble enough to remain responsive to client needs, yet large...

  • Customer Service Representative

    3 days ago

    Salem, United States Ingredion Full time

    TITLE: Customer Service Representative.LOCATION: SalemThe Customer Service Representative will Respond to customer inquiries via telephone or email to provide problem resolution to the organization's service standards. Core Responsibilities : Answer customer calls and emails, process orders and arrange transportation for the orders.Maintain orders in SAP or...

  • Client Relations Specialist

    1 week ago

    Salem, Virginia, United States FastSigns Full time

    FASTSIGNS #30502 is seeking a dedicated Customer Service Representative to enhance our operations.Benefits and Advantages:Attractive CompensationPaid Time Off and HolidaysContinuous Learning and Development OpportunitiesKey Responsibilities:Act as the primary point of contact for both existing and potential clients within our center.Acquire skills to...

  • Client Relations Specialist

    2 weeks ago

    Salem, Virginia, United States FastSigns Full time

    FASTSIGNS #30502 is seeking a dedicated Customer Service Representative to enhance our operations.Benefits and Perks:Competitive CompensationPaid Time Off and HolidaysContinuous Training and DevelopmentKey Responsibilities:Act as the primary point of contact for both existing and potential clients.Acquire skills to create estimates, manage work orders, and...

  • Associate Relations Specialist

    4 weeks ago

    Salem, United States ATD American Tire Distributors Full time

    Associate Relations Specialist in Remote, OR at American Tire Distributors Are you looking for an opportunity to turn your ambition and your people skills into a rewarding career with an industry leader? Join our team at American Tire Distributors! As the nation's premier tire distributor, ATD’s coast-to-coast distribution network provides approximately...