Provider Services Representative (Hybrid)

Village Care•New York, NY

11d•Hybrid

About The Position

Provider Services Representative VillageCareMAX 112 Charles Street, New York, NY 10014 MUST LIVE IN NJ/NY/CT VillageCareMAX is looking for a motivated individual for this Full Time role as the Provider Services Representative. This role is the primary point of contact between VillageCareMAX and contracted and/or non-contracted providers for our MLTC and Medicare lines of business for submitting Organization Determination requests. Some of your daily activities will include: Supporting our Utilization Management team and Member Experience team by maintaining incoming service requests to the department. Adhere to call center KPI requirements and Quality Assurance guidelines. Handle incoming requests from providers via ACD Calls and Faxes for compliance timeframes as well as performing outbound calls as needed to provide a first call resolution. Initiates Organization Determination requests upon requests from providers. Data enters authorizations under the direction of the Interdisciplinary Care Team when needed. We would like to speak to those who have an Associate degree or bachelor's degree in a related field along with 2+ years practical experience in healthcare setting. Excellent communication skills, organizational skills and problem solving will be vital to this position. Must reside within the New York Tri-State Area - NY, NJ, or CT. There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you! VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care. VillageCare is an Equal Opportunity Employer.

Requirements

Associate degree or bachelor's degree in a related field
2+ years practical experience in healthcare setting
Excellent communication skills
Organizational skills
Problem solving
Must reside within the New York Tri-State Area - NY, NJ, or CT

Responsibilities

Supporting our Utilization Management team and Member Experience team by maintaining incoming service requests to the department.
Adhere to call center KPI requirements and Quality Assurance guidelines.
Handle incoming requests from providers via ACD Calls and Faxes for compliance timeframes as well as performing outbound calls as needed to provide a first call resolution.
Initiates Organization Determination requests upon requests from providers.
Data enters authorizations under the direction of the Interdisciplinary Care Team when needed.