PROVIDER AND CLIENT SERVICES REPRESENTATIVE

About the role

The MSO Provider and Client Services Representative (PCSR) provides general administrative support to the MSO Department and works in conjunction with the MSO Value Based Care Programs team. This position handles inquiries from providers, vendors, and clients related to NEMS MSO operations such as claims processing, utilization management, and value-based care improvement activities. The PCSR works on projects and assignments of limited complexity in a supporting role.

This role requires excellent communication skills to interact effectively with a variety of professionals, including physicians, administrators, other healthcare providers, and service agencies.

Responsibilities

• Provide primary support for MSO Utilization Management and Claims main phone line, general mailbox, voicemails, faxes, and other administrative tasks.
• Research and understand basic authorizations, claims, provider appeals, and benefit coverage issues raised by physician practices and/or health plan partners; coordinate follow-up activities for resolution.
• Coordinate investigation activities for member grievances; track progress and report results to contracted Health Plan(s) within required timeframes.
• Assist the Value Based Care Programs team with outreach phone calls and other patient care improvement activities.
• Thoroughly and efficiently respond to all emails and/or voicemails requiring action in a timely manner.
• Complete other administrative and clerical tasks as assigned.
• Perform other job duties as required by manager/supervisor.

Qualifications

• BA/BS Degree preferred.
• One-year experience working in a healthcare setting preferred.
• Excellent communication skills (verbal and written), with the ability to communicate effectively with professionals such as physicians, healthcare providers, and business administrators.
• PC literate with strong skills in Excel, Word, PowerPoint, and Outlook.
• Detail-oriented and organized, with the ability to interpret policy and make decisions.
• Good organization and problem-solving skills.
• Ability to self-manage and work with multiple departments within the organization and external clients.
• Knowledge of managed care and Medicare/Medi-Cal programs is strongly preferred.

Language

• Must be able to fluently speak, read, and write English.
• Fluent in Chinese (Cantonese and/or Mandarin) preferred.
• Fluency in other languages is an asset.

Status

This is an FLSA Non-exempt position and is not an OSHA high-risk position.