Provider Relations Specialist

Job Description

Job Description

The Provider Relations Specialist reports to the Quality Assurance and Provider Relations Manager in the MWG-Administrators Division. The position a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES :

The Provider Relations Specialist serves as a vital connection between the MWGA Health Plans and the providers submitting claims for adjudication. This role is responsible for maintaining strong provider relationships, supporting providers, resolving operational issues, and promoting high levels of provider satisfaction. This is critical to correctly matching the provider's information to claims submission. Additionally, the position will work with the MWG Claims Department to provide a seamless workflow from provider verification to claims adjudication.

• Interact via written and verbal communication with providers regarding questions concerning claims and claims payments. Serve as a Primary Point of Contact for Providers.
• Import and validate claim files into the claims system for claim processing.
• Maintain Provider's demographic records for accurate claim processing and claim payments.
• Reissue and void claim payments through third party payment processor software.
• Investigate and resolve errors with claim importing.
• Process claim repull requests from the Claims Department.
• Conduct reporting and ad hoc reporting on various processes within multiple systems.
• Utilize MWG Administrators Policy Administration System and Claims Management Software to verify eligibility and review member accounts based on the policy assigned.
• Input data into the MWG Claims Management Software.
• Perform other duties as assigned by the department manager.
• Have a comprehensive knowledge and clear understanding of MWGA business processes internally and externally.

EXPERIENCE AND EDUCATION REQUIREMENTS :

WORKING ENVIRONMENT :

JOB ESSENTIAL REQUIREMENTS :

The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

REASONABLE ACCOMODATIONS :

Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship for Morgan White Group.

EQUAL OPPORTUNITY EMPLOYER :

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.