Provider Inquiry Representative I (Hybrid/Troy, MI) - Health Alliance Plan

Health Alliance Plan by Henry Ford Health is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

General Summary:

This position has the following primary objectives with respect to customer relations for all Health Alliance Plan product lines: (1) Provide courteous and prompt resolution to provider inquiries by conducting thorough investigations and fully educating provider/customers; with the goal of resolution upon initial customer contact; (2) Support corporate and departmental goals, provider engagement and education activities and product launches; (3) Research and investigate service failures and report to leadership; identify root cause and recommend resolutions for service recovery and retention.

Principal Duties and Responsibilities:

• Respond to inquiries received by telephone, mail and fax; research and answer inquiries, complaints and appeals by following all department standards, policies and procedures; direct inquiries via Pega to supporting departments for appropriate action and resolution.
• Educate existing and potential providers on policies, procedures, products, benefit plan and coverage provisions related to all Health Alliance Plan products.
• Document all incoming inquiries in Pega to track provider inquiries and communicate trends as they are identified.
• Practice and maintain confidentiality to Privacy and HIPAA regulations. Proactively seek training and development to enhance skills and abilities.
• Monitor workflow inbox and outstanding cases to ensure that all inquiries receive an appropriate response in a timely manner; Contact providers (by phone/or in writing), as needed, to ensure timely resolution and follow-up to inquiry.
• Interact with support departments in a professional manner to ensure provider needs are met. Develop and maintain strong business relationships with inter-departments; Continue to self-educate on changes in policies and procedures that occur in other departments which could have an impact on department operations and the servicing of provider/customers.
• Attend training and development sessions or continuing education opportunities offered by Customer Services and maintain enhanced skill levels and performance.
• Interact with providers and the staff at the billing offices to obtain information for resolving customer inquiries/complaints.
• Ensure and maintain compliance of all department and corporate standards, policies and procedures.
• Recommend process improvements based on observations and trends identified while interacting with internal and external customers.
• Perform other related duties as assigned.

Education Required:

• Associate’s Degree in Business or related field or minimum four (4) years of related experience may be considered in lieu of degree.
• Course in Medical Terminology (will be requirement to complete post-employment).

Experience Required:

• Minimum of two (2) years of recent Customer Service or Call Center experience within the last three years (Claims Call Center experience preferred).
• At least one (1) year of healthcare provider claims processing or billing experience or at least 1 year experience servicing healthcare providers relative to claims and benefits in a managed care setting within the last 5 years.

Skills and Abilities:

• Must be dependable
• Handle assigned projects from start to successful completion
• Handle multiple priorities concurrently in a timely and accurate manner
• Demonstrate excellent listening, verbal and written communication skills
• Demonstrate excellent problem solving skills
• Must have strong interpersonal skills
• Demonstrate a high degree of integrity, patience, maturity, empathy, tact and diplomacy
• Demonstrate flexibility, good judgment and ability to provide service excellence
• Business writing skills
• Efficiency in using a PC and various Microsoft programs
• Fundamental understanding of HMO/PPO/POS delivery system and claims billing
• Must be able to work flexible shifts