Responsible for the day to day managing of provider issues and concerns. Acts as a liaison/advocate between the provider network and internal departments. Works directly with practice managers, billing agencies, and physicians via phone, email or in-person to assist in resolving challenges. He/she is responsible for managing all operational aspects of the provider relationship. This will include assigned and unassigned accounts.
He/she will serve as SME for the network and will be responsive for all incoming inquiries (for all channels, phone, e-mail, mail) regarding current claims, escalated issues, and strategic planning.
He/she works collaboratively with business and operational units such as Claims Production, Provider Claims Services (call center), Quality Control, and Reconsideration Specialist to ensure proper and cohesive claims communication to providers. Acts as the lead point of contact for any and all matters specific to customers and claims that have been escalated.
He/she assumes ownership and accountability for the timely and accurate identification and resolution of claims issues through reporting, research, and testing.
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at firstname.lastname@example.org.
Neighborhood is an EOE M/F/D/V and an E-Verify Employer