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Prov Svc Rep/23/NMT081
Specific Duties:
- Process single case agreements with facilities and clinicians for the Exchange line of business.
- Provide service support to Intake, Claims, and Care Management teams to ensure timely access to behavioral health services for members.
- Handle single case agreement requests while meeting departmental financial and service standards.
- Respond to all phone calls and emails pertaining to single case agreements.
- Update internal staff regarding potential single case agreement delays/and or barriers.
- Timely and accurate communication in executing single case agreements.
- Update appropriate systems regarding outcome of single case agreements.
- Consistently provider searches to review providers network status.
- Meet turnaround time objectives mandated by customers and state requirements.
- Partner with network contracting staff regarding providers interested in contracting.
- Accurate data entry of all single case agreement information in systems.
- Complete company required training
- Other duties as assigned.
- 1+ years of experience in Claim Processing or healthcare operations.
- Knowledge of insurance payer guidelines, authorization requirements, and medical terminology.
- Strong organizational, multitasking, and communication skills in a fast-paced environment.
- Location: Remote
- Job Type: 3+ months contract to hire
- Schedule: Monday - Friday
- Office Hours: 8:30am-5pm
- Pay Range: $12-13/hr. on W2
#PHCUHGClinical
#PHCUHGZip
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Equal Employment Opportunity
PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.
Fair Chance Employment
PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.
Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.
Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.
Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.
Pride Health is Pride Global's healthcare staffing, providing recruitment solutions for healthcare professionals and the industry at large since 2010.
Pride Health delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds. Our expert staff provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment full of trust and loyalty.
