Provider Resource Center Representative / MN Health Insurance Program Representative 1

About the role

The Provider Resource Center Representative works in a customer service oriented, in-bound call center work environment answering a high volume of calls from health care providers with limited direction from supervisor.

Responsibilities

• Multi-tasking and analytical skills using multiple computer systems and applications open on the desktop to retrieve information from all sources to complete the call
• Answering questions from enrolled providers and prospective providers regarding a wide variety of topics including benefits, coverage, claims, authorizations, enrollment and eligibility
• Analyze, investigate, triage, resolve or assist in the resolution of the callers concerns, highly complex issues or provide additional resources, referrals or support, within given parameters
• Balance the need to expeditiously service a continuous flow of customers with a focus of ensuring quality service, excellent customer service and relaying accurate, detailed, relevant information
• Develop and maintain ongoing working relationships with provider groups, their billing practices, medical services/procedures, pharmaceuticals and claims processing cycles
• Become versed in and able to apply policy, procedures, coding and forms used in association with provider types and transactions
• Instruct providers on procedures, forms and codes used in association with MMIS and MN–ITS systems
• Provide step by step procedures with sensitivity to individual learning differences and instruct callers through processes
• Ability to maintain confidentiality regarding provider information

Minimum Qualifications

• Two years of customer service experience
• One year of experience in a high volume, deadline driven and accuracy-focused call center environment answering phone calls and meeting performance and production standards
• Ability to administer policies, procedures, and systems used to make eligibility determinations
• Strong computer skills with the ability to navigate multiple software applications, databases, as well as possessing data entry skills
• Strong customer service skills and effective oral and written communication
• Ability to read, speak and write English well enough to understand, apply and explain complex eligibility policies
• Quickly adapt to changing policies and procedures
• Ability to work within a high volume, deadline-orientated, and accuracy-focused program where performance and production standards must be met
• Ability to multi-task and work independently with a strong work ethic and demonstrated record of regular attendance

Preferred Qualifications

• Experience involving decision-making and customer service responsibility within a complex policy environment (e.g. applying eligibility, insurance, health care, or service industry policy while dealing with a high volume customer base)
• Experience with the Medical Management Information System (MMIS) payment and eligibility system
• Experience with health care billing
• Experience with electronic data interchange (EDI)
• Experience working in a health care call center
• Experience with Minnesota Health Care Programs (MHCP) claims
• Familiarity with medical terminology
• Variety of experiences working effectively with others from different backgrounds and/or cultures

Additional Requirements

This position requires successful completion of the following:

• Criminal background check
• Reference check
• Fingerprinting check (MNJIS/CJIS)
• Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3 business days from the start of employment; and successfully obtain/retain CJIS certification annually.