Provider Center Representative Banner Plans and Networks Job Mesa area,Arizona USA,Healthcare

Position: Provider Experience Center Representative Banner Plans and Networks

Primary City/State:

Mesa, Arizona

Department Name:

Provider Relations

Work Shift:

Day

Job Category:

Marketing and Communications

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

As a Provider Experience Representative for Banner Plans & Networks you will take inbound calls answering questions from providers and their staff members. You will call upon your background in medical billing, medical claims, customer service, and managed care to answer complex questions and find solutions regarding coverage, benefits and other coverage inquiries. You will be working in a fast paced and multitasking environment while providing excellent customer service and satisfaction with a goal of first call resolution.

As a Provider Experience Representative , you will be working in a hybrid/remote setting. Your work shifts will be Monday - Friday within the hours of 8:00a.m - 5:00p.m. Arizona Time Zone. If this role sounds like the one for you, Apply Today!

This position can be Remote if you are located in the Phoenix Metro or Tucson area only.

Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION

SUMMARY

This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. May be assigned to work in a variety of administrative duties relative to supporting the provider community.

CORE

FUNCTIONS

Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.)

Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department’s ongoing goals and objectives.

Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians’ office staff.

Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms.

Assists internal departments in resolving provider appeals pertaining to the organization’s physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organization’s insurance plan administration staff.

Works on special projects as assigned.

Services inbound and outbound…


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