Provider Services Representative, Michigan

McLaren Health Care • Flint, MI

2d • Onsite

About The Position

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier, more satisfying lives. MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, and working with Provider Relations to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.

Requirements

• High School Diploma or equivalent certification.
• Two (2) years' experience in a physician health care office environment or high-volume call center.

Nice To Haves

• Associate degree in business, health care, or related field.
• Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO, and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements, and actuarial precepts).
• In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.

Responsibilities

• Handle daily provider telephone calls, including problem-solving, eligibility, and benefit inquiries.
• Resolve claims issues for providers.
• Provide linkage to the Medical Management Department for authorization of services.
• Act as an advocate for providers by supplying information and education.
• Collaborate with Provider Relations to address provider issues.
• Assist members with eligibility, benefit, and claims issue resolution as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED