The Provider Services Specialist is responsible for the full range of provider relations and service interactions within SWHP, including working on end-to-end provider claim and call quality, ease of use of provider portal and future service enhancements. This position reports directly to the Director of Provider Relations.
ESSENTIAL FUNCTIONS OF THE ROLE
Interprets SWHP policies and facilitates the research required to resolve provider issues. This position may be asked to manage all administrative aspects of provider issue resolution.
Responds to physician, hospital and ancillary provider inquiries and requests for services associated with the resolution of provider complaints, claim processing, appeals issues, and various operational concerns.
The Provider Services Specialist will assist the data analyst in the review of provider directories in order to maintain data integrity. Also updates provider information in Cactus and assists with reporting as needed.
Receive calls and correspondence from physicians, hospitals and ancillary providers requesting information and services.
Act as primary point of contact with providers by promoting a one-stop customer service.
Facilitate business activities through triage and coordination of resources according to priority of need.
Monitor status of resolution through maintaining detailed documentation of issue and action to date and conduct proactive follow-up activities with provider and/or SWHP staff.
Adhere to departmental and organization standards such as service level, issue resolution timeframes.
Assist and support Provider Services Representative on project assignments such as claims and referral issues, welcome letters and in the education of providers on SWHP policy and procedures.
Escalate critical issues and conflicts to Director of Provider Relations or Provider Services Representative.
Participate in departmental and interdepartmental meetings as appropriate and necessary. As well as Participate in ad hoc projects as necessary.
Maintain professional growth and development through self directed learning activities.
KEY SUCCESS FACTORS
Must be able to work independently.
Must be highly organized and able to manage multiple providers at once.
Must be able to write and speak clearly and effectively.
Ability to work under pressure.
Knowledge of the managed care/ health care industry preferred.
Demonstrated ability to manage projects from conception through implementation.
Must also have knowledge in working with computer systems, Microsoft Word, Excel and other software applications.
Knowledge of medical terminology.
Knowledge of medical care specialties.
Skill in eliciting and relating information clearly and concisely.
Skill in exercising diplomacy in communicating with clients, patients, and medical professionals.
- EDUCATION - Assoc or Equiv Experience
- EXPERIENCE - A minimum of 5 years experience required
Internal Number: 20011102
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!