Claims Specialist, Provider Engagement Lead

7 days ago

Roseburg, Oregon, United States Umpqua Health Full time

At Umpqua Health, we strive to deliver high-quality healthcare services that cater to the diverse needs of our community. Our comprehensive approach to care encompasses primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated support.

We're committed to fostering a supportive environment where every team member plays a vital role in our mission. From preventative care to managing chronic conditions, we aim to empower healthier lives and build a stronger, healthier community together.

As an equal opportunity employer, Umpqua Health prohibits discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business.

About the Role

The Claims Specialist, Provider Relations plays a multifaceted role in fostering positive relationships between our organization and healthcare providers. This position involves taking incoming calls from provider offices handling claims and other concerns, coordinating secret shopper calls, monitoring service access, gathering data for quality assurance measures, and performing other administrative duties.

  • Taking incoming phone calls from providers' offices to address claim problems and concerns
  • Gathering data from vendors and coordinating secret shopper calls to evaluate provider performance, customer service, and adherence to service standards
  • Documenting findings accurately and providing actionable feedback to improve provider-patient interactions
  • Collaborating with providers to address issues or concerns related to service quality and adherence to guidelines
  • Compiling reports and presentations to communicate findings and recommend strategies for improvement
  • Utilizing healthcare management software and databases to maintain accurate records and track performance metrics
  • Supporting the development and implementation of training programs to educate providers on our organization's services, protocols, and standards
  • Assisting with administrative tasks such as scheduling meetings, maintaining calendars, and coordinating logistics for events or training sessions
  • Serving as a liaison between providers and internal departments to facilitate communication and address administrative needs
Your Impact

This role offers an excellent opportunity to make a meaningful impact on the delivery of healthcare services. As a Claims Specialist, Provider Relations, you will be instrumental in improving provider-patient interactions, enhancing service quality, and driving positive change within our organization.

Your Credentials

To succeed in this role, you will need:

  • A High School Diploma/GED and related field or equivalent experience
  • 1+ years of experience in provider relations, healthcare administration, or in claims or billing
  • Excellent customer service skills
  • Strong understanding of healthcare operations, regulations, and industry trends
  • Excellent communication, negotiation, and interpersonal skills
  • An analytical mindset with the ability to interpret data and identify trends
  • Proficiency in Microsoft Office Suite and healthcare management software
  • Experience in coordinating secret shopper calls and quality assurance monitoring preferred

We offer a competitive salary of $65,000 - $80,000 per year, depending on your level of experience and qualifications. If you are passionate about delivering exceptional healthcare services and making a difference in our community, we encourage you to apply for this exciting opportunity.

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