Provider Support Specialist

1 week ago


Springfield, Massachusetts, United States Health New England Full time
Job Summary

Contribute to the success of the Provider Experience team by ensuring specific individual goals, plans, and initiatives are executed in support of the team's business strategies and objectives. Ensure all activities conducted are in compliance with governing regulations, internal policies, and procedures.

Key Responsibilities
  • Champion a customer-focused culture to deepen client relationships and leverage broader Health New England's relationships, systems, and knowledge.
  • Actively pursue effective and efficient operations of their respective areas in accordance with Health New England's Values, its Code of Conduct, and the Associate Handbook, while ensuring the adequacy, adherence to, and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.
  • Accepts inbound calls and email inquiries/requests from providers and responds according to the processes, procedures, and decision matrices referenced in the team training.
  • Employs the on-line resources to ensure that consistent and accurate information is relayed to providers with regard to inquiries and requests etc.
  • Researches low to medium complexity issues using established protocols and communicates to providers using approved media and standards.
  • Follows the established processes and procedures for addressing or reassigning provider inquiries, requests, or grievances including: root cause determination, standard and non-standard resolution options, expected timelines for resolution, and provider communication protocols.
  • Identifies escalated issues and leverages the Provider Support team as well as other HNE functional areas to diffuse situations.
  • Documents interactions, resolution, or reassignment of issues in the established repository tools and within the established standards and timeframes.
Requirements
  • Bachelor's degree or an equivalent combination of education and experience in business or a related field with a minimum of five years healthcare/provider servicing experience.
  • Demonstrated proficiency in the area of provider servicing, support, and issue resolution.
  • Basic knowledge of provider reimbursement and claims payment mechanisms.
  • Broad-based knowledge of Medicare, Medicaid, and commercial product offerings.
  • Proficiency with Microsoft applications and applications specific to HNE.


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