The Provider Services Specialist 2 is responsible for the full range of provider service interactions, including provider enrollment, provider data, maintenance of the provider data management systems, end-to-end provider issues and quality, ease of use of provider portal and future service enhancements.
ESSENTIAL FUNCTIONS OF THE ROLE
Works directly with providers to resolve issues with provider data and participation, and performs administrative related duties to ensure provider issue resolution.
Responds to physician, hospital and ancillary provider inquiries and requests for services associated with the resolution of provider complaints, issues and various operational concerns. Receives calls and correspondence from physicians, hospitals and ancillary providers requesting information and services.
Acts as primary point of contact with providers by promoting a one-stop customer service experience. Identifies appropriate internal resources in order to resolve issues. Interprets policies and facilitates the research required to resolve provider issues. Monitors status of resolutions through maintaining detailed documentation of issues and actions. Conducts proactive follow-up activities with provider and/or internal staff.
Adheres to departmental and organization standards (service level, issue resolution timeframes).
Assists and supports on project assignments such as issues, welcome letters and in the education of providers on policies and procedures.
Facilitates business activities through triage and coordination of resources according to priority of need.
Assists in the review of provider data for directories in order to maintain data integrity. Updates provider information in the system and assists with reporting, as needed.
KEY SUCCESS FACTORS
Able to work independently.
Must be highly organized and able to manage multiple providers at once.
Able to write and speak clearly and effectively.
Able to work under pressure.
Knowledge of the managed care/ health care industry required.
Demonstrated ability to manage projects from conception through implementation.
Skill in the use of computers and related software.
Expertise in eliciting and relating information clearly and concisely.
Skill in exercising diplomacy in communicating with clients, patients, and medical professionals.
Knowledge of medical terminology preferred.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
- EDUCATION - Associate's or 2 years of work experience above the minimum qualification
- EXPERIENCE - 3 Years of Experience, Health Plan experience very highly preferred
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!