PacificSource Health Plans

Provider Services Representative

US-OR-Tigard
Job ID
2017-19
Type
Regular Full-Time
Hiring Pay Range
$45,000 - $55,000 annually
# of Openings
1
Status
Exempt

Overview

Maintain positive public relations with provider groups, hospitals and clinic administrators across all business lines. Act as a personal contact for training, materials distribution, and as an information resource. Work throughout the PacificSource service area to educate provider office staff on current coding and PacificSource administrative and claims procedures. Act as a leading resource for cross functional, complex problem-solving within the Provider Network Department.

 

Responsibilities

  1. Visit provider groups for on-site service calls to update office staff on PacificSource products, administrative and claims procedures, and current coding issues pertaining to all business lines.
  2. Visit newly contracted providers within eight weeks of contract implementation. Work to resolve potential problems before they become an issue with the provider groups and work to ensure satisfaction with PacificSource. Distribute a variety of claims analysis reports and other information pertaining to the provider’s practice.
  3. Provide follow-up on behalf of Customer Service and other PacificSource departments regarding participating providers’ contract questions or compliance issues across all business lines.
  4. Act as a liaison for PacificSource between provider groups, PacificSource members, and PacificSource to resolve problems and comply with requests. Communicate with provider offices and their staffs, PacificSource departments, PacificSource Special Investigations Unit, and Provider Network Contract Account Lead. Document problems, issues, and resolution in provider files or call tracking as needed.
  5. Primarily responsible for the development and maintenance of the Provider Manual. Thoroughly explain the Provider Manual, provider contract, member plan information, and other information during on-site service calls and as needed, drawing on extensive knowledge of materials and policies. Review documents before delivery to ensure accuracy. May assemble materials and other collateral information prior to delivery.
  6. Demonstrate proficiency in performing provider education and introductory meetings and presentations, including PacificSource mission and business, InTouch functionality and registration, claims procedures, administrative procedures, member plan information, provider networks, and how to access appropriate forms and information on the PacificSource website as well as contacting appropriate PacificSource representatives for assistance. Prepare materials and presentations for the meetings.
  7. Provide education both in person and on the phone about InTouch functionality and troubleshooting.
  8. Prepare and maintain provider service files.
  9. Assist in the maintenance of provider demographics and serve as a resource to internal personal and provider office staff regarding participating provider maintenance.
  10. Perform operational tasks related to participating provider set-up and take necessary action to assure accurate internal implementation.
  11. Participate in the publication and mailing of the quarterly provider newsletters by gathering information and writing articles.
  12. Coordinate and facilitate distribution of codebook publications for the provider community.
  13. Speak as a PacificSource representative at provider-related functions. Attend provider-related conferences as a vendor in order to distribute information, network, and answer questions about PacificSource.
  14. Place supply orders and update inventory of PacificSource logo give-away products.
  15. Participate in local medical organizations such as Medical Assistants Organization and local chapters of the American Academy of Professional Coders (AAPC).
  16. Develop positive working relationships with provider groups and their staff to assure that providers’ concerns are addressed by the appropriate person(s) in a timely, responsive manner. Provide prompt, professional, and courteous service to providers, members, and PacificSource employees.
  17. Engage in intradepartmental projects and be able to participate knowledgeably and collaboratively to ensure success for department initiatives.
  18. If necessary, act as the sole departmental representative on cross-departmental initiatives, with broad, effective knowledge of all aspects of departmental functions.
  19. As needed and consistent with proficiency and experience, participate in elements of training for employees who are new to the department.
  20. Able to confidently interact with all levels of management at PacificSource, on an as-needed basis.

Supporting Responsibilities:

  1. Meet department and company performance and attendance expectations.
  2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  3. Perform other duties as assigned.
  4. Meet department and company performance and attendance expectations.
  5. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  6. Perform other duties as assigned.

Qualifications

Work Experience:  2 years’ experience as a Provider Service Specialist within PacificSource, or 5 years’ experience in related healthcare field.

 

Education, Certificates, Licenses:  High school diploma or equivalent. A CPC or CPC-P certification is recommended.

 

Knowledge:  Excellent written and oral communication, including diplomacy skills for working with the medical professional community as well as the members enrolled in a PacificSource plan. Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Ability to read, understand and communicate PacificSource policy. Effective problem solving skills. Ability to read, understand, and communicate provider contractual agreements. Medical terminology proficiency. Experience or education in ICD-10-CM and coding. General computer, word processing and spreadsheet skills. General clerical skills. Ability to remain current on PacificSource administrative and claims procedures, healthcare and the health insurance industry, and claims coding issues. Excellent public relations skills. Ability to prioritize work. Current Oregon driver’s license. Travel throughout the state, generally by automobile, with some overnight visits required.

 

Competencies

Our Values

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards

 

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for our customers’ experience.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our communities-internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

 

Environment:  Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.

 

Physical Requirements:  Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions.  Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

 

Disclaimer:  This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

 

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

 

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