Provider Relations Associate Analyst

Please see attached qualifying questions prior to submitting candidates to request

Please Note : this position is fully remote / work from home. At this time, candidates must be willing to complete all training and work from their home.

Evernorth will supply all equipment, however, high speed internet is required.

Candidates must have reliable high speed internet connection at home - this will NOT be provided

Manager seeking candidates located anywhere in the Candiates located in PST or MST are ideal to staff our late shift.

Please Note : hours during training are : am- : pm CST. After all of the training is completed, the hours for this position will be : am- : pm CST.

Contractors will initially be trained to take calls regarding Eligibility and Benefits from Behavioral Health Providers.

This initial training is required before learning how to service Claim and PR (Provider Relations) calls. Timing for the Claim and PR training is yet to be determined, and will be based on business need.

Job Description and Role Summary

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff.

Occasional outbound calls are required to resolve claim issues.

The types of calls a Claims & PR Advocate services may include but are not limited to : inquiries about claim status details, claim reprocessing requests, provider contract questions or requests to update demographics.

Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call.

Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role.

Calls must be serviced in a helpful and professional manner.

Responsibilities :

The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.

The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up.

Within a call a Claims & PR Advocate may :

Assist a member or provider with understanding how a claim has processed

Verify claim status for a member or provider

Educate a member or provider on billing protocols

Write or correct authorizations to ensure claims are paid correctly

Send claims for adjustment / reprocessing

Request duplicate EOBs for a member or provider

Send a request for a cancelled check copy, to reissue a check, or request a stop pay / do not reissue on a check

Provide follow-up on issues by making outbound calls when necessary

Send resources to members and providers via email

Submit a complaint on the member or provider’s behalf

Send handoff requets to matrix partners for escalated or complex issues

Assist providers with contract related inquiries and demographic updates

Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved

Skills

Customer Service experience

Able to excel and / or prior successful experience in a virtual team environment

Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.

Candidate must possess superb interpersonal communication skills

Effective listening and organizational skills, with the ability to manage multiple tasks

Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications

Independent problem-solving skills

Strong time management skills

Ability to type effectively and have strong PC skills

Training

Training hours are Monday through Friday : AM : PM CST.

Work Schedule

After all of the training is completed, the hours for this position will be : am- : pm CST.

Attendance Policy

Maintaining good attendance is important for all contractors and is particularly important for those newly hired to the assignment.

The Corrective Action process for a contractor who incurs an unscheduled or unapproved absence or event in his / her first days of assignment is outlined below.

st unapproved absence or event will result in a Verbal Counseling.

nd unapproved absence or event will result in a First Notice.

rd unapproved absence or event will result in a Final Notice.

th unapproved absence or event will result in termination.

Late Arrivals / Early Departures

Late arrivals and early departures without the appropriate notifications count towards an unscheduled, unapproved absence.

Based on business need, a manager may allow a contractor to make-up the time during that business day. However, this does not excuse the behavior.

Recording of Late arrivals

If an Advocate is late for any reason the following will determine how their time is recorded :

minutes to minutes will be recorded as an occurrence.

minutes to minutes will be recorded as an occurrence and time may be made up on the same day at the manager’s discretion.

minutes or more will be recorded as an occurrence and time will be recorded as unscheduled time off. No portion of this time can be made up.

Any exceptions will be determined by the Supervisors.

If the attendance issues become excessive and / or if a trend develops that adversely impacts the contractor’s productivity, performance and / or contribution to the organization, management may accelerate the corrective action process.