Provider Experience Center Representative

Banner Health•Phoenix, AZ

2d•$20 - $31•Remote

About The Position

As a Provider Experience Representative for Banner Plans & Networks, you will respond to inbound calls from providers and their staff, using knowledge of medical billing, medical claims, customer service, and managed care to address complex questions about coverage, benefits, and related inquiries. The role operates in a fast-paced, multitasking environment and aims to provide excellent customer service and first-call resolution. This position is remote and requires residence in Arizona. Work shifts are Monday through Friday within the hours of 8:00 a.m. to 5:00 p.m. Banner Staffing Services roles are assignment-based, have no guaranteed hours, and may conclude at any time; they do not offer medical benefits or paid time off accrual. The position provides daily customer service expertise to physicians and staff of affiliated and non-affiliated Banner Health Network providers. Representatives serve as a primary resource for complex or sensitive cases and may perform administrative duties supporting the provider community. The role works under limited supervision, exercises independent judgment on complex provider matters, collaborates with internal and external parties to research and resolve issues, and meets department quality, quantity, and timeliness standards.

Requirements

High school diploma/GED or equivalent working knowledge.
Three to four years of substantial related experience in healthcare services, a high-volume service center, or a managed care environment.
Ability to multitask between inbound calls and searching databases or resource tools while maintaining a professional demeanor.
Excellent verbal and written communication skills and a positive, helpful customer-service attitude.
Ability to meet deadlines in a multifunctional task environment.
Excellent organizational skills and operational knowledge of word processing, spreadsheets, data entry, fax machines, and other computer-related tools.
Ability to learn and use provider information systems and develop fundamental knowledge of organizational expectations.
Ability to maintain efficiency and timeliness, establish daily work priorities, and contribute to a successful provider experience.
Must reside in Arizona.

Nice To Haves

Associate degree, or equivalent business and/or healthcare knowledge.
One to two years of experience in medical claims adjudication, contract interpretation, billing and coding, and medical terminology.
Additional related education and/or experience.

Responsibilities

Receive, document, research, and respond to provider inquiries and escalated calls in accordance with policies, procedures, and compliance guidelines.
Handle a diverse, high volume of inbound and outbound health insurance provider calls, including identifying issues, researching them, documenting interactions, and responding to providers.
Collaborate with appropriate parties to deliver customer service and facilitate timely research and issue resolution.
Provide accurate, timely information about claims, benefits, member out-of-pocket expenses, and payments by telephone or in writing.
Verify claim adjudication payments independently and in accordance with plan guidelines; analyze cases and follow up to obtain necessary information from providers, facilities, and office staff.
Identify and resolve managed care issues involving claims, contract interpretation, utilization management, eligibility, and general operations.
Interpret contract language and resolve contract issues by reviewing contract terms; serve as a resource for internal and external clients.
Assist internal departments with provider appeals concerning the organization’s physicians, hospitals, and insurance plan contracts.
Educate physicians, office staff, hospitals, and insurance plan administration staff.
Work on special projects as assigned.
Communicate with providers and office staff for facilities and physician offices in the states where the organization operates.
Handle physician inquiries and problems within the role’s scope, keep supervisors apprised of issues, and meet department performance and compliance standards.
Set work priorities and complete tasks efficiently with minimal supervision and instruction.