BSS Provider Experience Rep Health Plans Call Center

Primary City/State: Mesa, Arizona

Department Name:

Banner Staffing Services-AZ

Work Shift:

Day

Job Category:

Marketing and Communications

Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. Learn more at

The future is full of possibilities. At Banner Staffing Services, we’re excited about what the future holds for health care. Our team has come together with the common goal: Make health care easier, so life can be better. If you’re ready to change lives, apply today.

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.

As a valued and respected Banner Health team member, you will enjoy:

• Competitive wages

• Paid orientation

• Flexible Schedules (select positions)

• Fewer Shifts Cancelled

• Weekly pay

• 403(b) Pre-tax retirement

• Resources for living (Employee Assistance Program)

• MyWell-Being (Wellness program)

• Discount Entertainment tickets

• Restaurant/Shopping discounts

Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes employment, criminal and education) is required.

If this Banner Staffing Services role sounds like the right one for you, Apply Today!

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
1. 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.)


2. 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.


3. 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.


4. 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.


5. 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.


6. Works on special projects as assigned.


7. Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network. Makes decisions within structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion. Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur. Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with minimal supervision and instruction.


MINIMUM QUALIFICATIONS


High school diploma/GED or equivalent working knowledge.


Must have substantial previous related work experience in healthcare services, with three to four years of experience in a high volume service center or managed care environment. Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at all times.


Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills. Must have the ability to acquire and utilize a sound knowledge of the company’s provider information systems, as well as, fundamental knowledge of the organization’s expectations. Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall provider experience.


PREFERRED QUALIFICATIONS

Experience with a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate’s degree. The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology.


Additional related education and/or experience preferred.

EEO Statement:

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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