Community relations [h1.location_city]

Provider Relations Specialist

Provider Relations Specialist I is responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers. Provider Relations Specialist II is responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.

Primary responsibilities include utilizing ACD phone lines to manage incoming calls and inquiries, providing high level of customer service for all internal or external customers thru telephonic, email and fax, managing confidential client information with discretion and good judgement in accordance with department and company guidelines, identifying problems, providing solutions and resolving promptly, responding to written or verbal provider inquiries relating to our bill review analysis, analyzing problems using problem solving methodology skills to determine root cause; communicating and implementing solutions, and performing technical review of more complex medical bills, including but not limited to modifiers, anesthesia, & psychiatric.

Employment qualifications include a high school diploma or G.E.D. for Provider Relations Specialists I, and a certificate in medical billing for Provider Relations Specialists II. Experience required includes three-year general office experience including answering inquiries over the phone for Provider Relations Specialists I, and two years as a Provider Relations Specialist I or three years' experience in an insurance organization with two years demonstrated technical knowledge in workers' compensation medical bill review for Provider Relations Specialists II.

Skills / knowledge / abilities required include excellent customer service skills, excellent telephone etiquette, knowledge of multi-functional phone system, ability to obtain pertinent and thorough information from customers, knowledge of computers and spreadsheet software, ability to type 40 wpm accurately, ability to proofread documents for accuracy of spelling, grammar, punctuation, and format, ability to perform mathematical calculations with the ability to use a ten-key pad with accuracy, ability to multi-task, i.e., interact on telephone while entering data, ability to manage work with minimal direction, excellent oral and written communication, demonstrate attention to detail, ability to consistently meet or exceed daily production and quality standard for this position, working knowledge, experience, and ability to process bills using state medical payment methodologies, ability to use independent discretion to make choices on proper reimbursement, thorough knowledge of Worker's Compensation multi state medical fee schedules, Medical guidelines, medical terminology and CPT / ICD-CM, and basic knowledge of Workers Compensation Act.

Work is performed in an office setting with no unusual hazards.