Provider Relations Specialist at PacificSource in Portland, Oregon

Job Description:

Looking for a way to make an impact and help people?



Join PacificSource and help our members access quality, affordable care!



PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.




Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.


Responsible for answering general inquiries from providers. Maintain positive public relations with provider groups and clinic administrators. Act as a contact for problem solving, materials distribution, and as an information resource. Responsibilities will include responding to provider emails and phone calls, customer service tasks, validation and entry of the Electronic Funds Transfer (EFT) requests.



Essential Responsibilities:

• Provide prompt, professional, positive, and courteous service to internal and external customers.


• Review state email inbox, resolve basic inquiries and delegate complex issues to appropriate team.


• Route secure uploads to appropriate internal teams.


• Answer calls and questions from internal and external sources through department's phone queue.


• Perform EFT data validation, fraud review, and Facets loading and implementation.


• Responsible for completing customer service tasks in a timely manner.


• Complete fee schedule and contract pricing inquiries.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.


• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.


• Perform other duties as assigned.

SUCCESS PROFILE




Work Experience: 2 years of experience in provider relations or other related healthcare role required.



Education, Certificates, Licenses: High school diploma or equivalent required.



Knowledge: Foundational knowledge in ICD-10-CM and coding. General computer, word processing and spreadsheet skills. Ability to remain current on claims procedures, healthcare and the health insurance industry, and claims coding issues. Limited experience in public relations. Effective written and oral communication. Ability to effectively explain administrative and claims procedures to provider office staff of varying educational backgrounds and familiarity with insurance billing.



Competencies



Adaptability


Building Customer Loyalty


Building Strategic Work Relationships


Building Trust


Continuous Improvement


Contributing to Team Success


Planning and Organizing


Work Standards



Environment: Work inside in a general office setting with ergonomically configured equipment. Occasional travel is required.



Skills:

Accountability, Communication, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork



Our Values



We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.


• We are one team working toward a common goal.


• We are each responsible for customer service.


• We practice open communication at all levels of the company to foster individual, team and company growth.


• We actively participate in efforts to improve our many communities-internally and externally.


• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.


• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.



Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. Apply Now