Job Information
CareOregon Inc. Provider Customer Service Representative in Seattle, Washington
Career Opportunities: Provider Customer Service Representative (24384) Requisition ID 24384 - Posted 07/02/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (9) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Position Title: Provider Customer Service Representative Employment Status: Non-Exempt Department: Customer Experience Title of Manager: Provider Customer Service Supervisor Supervises: N/A Requisition: 24384 Pay & Benefits: Estimated hiring range $46,540 - $56,880 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes: Working hours; Monday - Friday, 8:00 AM to 5:00 PM - This is a fully remote position, but you must reside in one of the listed 9 states. General Statement of Duties The Provider Customer Service Representative is the initial point of contact for the CareOregon Provider Network which includes contracted providers, non-contracted providers and those providers interested in contracting. Aspects of excellent provider customer service delivery include giving information about the Oregon Health Plan, Medicaid, Medicare, Coordinated Care Organizations and Medical, Dental and/or Mental Health benefits. Representatives primarily handle issues related to provider and claim inquiries. Essential Position Functions Research, verify and resolve inquiries relating to Oregon Health Plan and Medicare eligibility Respond and assist providers with Primary Care Provider (PCP) assignments Collaborate with others inside and outside department to explain benefits not covered by Oregon Health Plan and provide information on community resources when appropriate Work collaboratively with providers ensure effective customer service and the resolution of health plan problems (e.g., claims, eligibility, and system related issues) Use online Call Tracking system to document all activities from any mode of communication from providers Arrange interpretation services for provider/clinic staff as needed Maintain confidentiality for all customers in accordance to Health Insurance Portability and Accountability Act (HIPAA) guidelines Treat all customers with honesty, courtesy, dignity and respect Provide customers with professional, timely and competent service Provide proactive, value added service by identifying and reporting system issues Consistently meet or exceed Department and Company standards and expectations including but not limited to quality, production and attendance Handle claim inquiries from providers and other customers in an effective and proactive manner May participate in Accelerated Process Improvement (API) teams and represent the Provider Customer Service department on other committees Essential Department and Organizational Functions Report to work as scheduled Act in compliance with the company Code of Conduct Collaborate with others inside and outside department to achieve business plan/goals Perform other duties and projects as assigned Knowledge, Skills and Abilities Required Ability to learn and apply State Oregon Administrative Rules (OARs), Federal laws and other regulatory agencies that relate to the medical health insurance industry and the Medicaid/Medicare industry Basic team building skills Ability to proactively work to build and improve the department Demonstrates a positive attitude and constructive communication style at all times Ability to be a positive and influential role model for other department team members Ability to take the initiative to see beyond the origi
