Provider Relations Specialist Position Available In Madison, Mississippi

Provider Relations Specialist Morgan White Group – 4.3

Ridgeland, MS Job Details Full-time Estimated:

$31.8K – $38.4K a year 2 days ago Qualifications Microsoft Word Spanish Microsoft Excel Microsoft Outlook Customer service English Windows High school diploma or GED Bachelor’s degree Computer skills Typing 1 year Associate’s degree Communication skills Entry level Full Job Description The Provider Relations Specialist reports to the Quality Assurance and Provider Relations Manager in the MWG-Administrators Division. The position a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES

The Provider Relations Specialist serves as a vital connection between the MWGA Health Plans and the providers submitting claims for adjudication. This role is responsible for maintaining strong provider relationships, supporting providers, resolving operational issues, and promoting high levels of provider satisfaction. This is critical to correctly matching the provider’s information to claims submission. Additionally, the position will work with the MWG Claims Department to provide a seamless workflow from provider verification to claims adjudication. Interact via written and verbal communication with providers regarding questions concerning claims and claims payments. Serve as a Primary Point of Contact for Providers. Import and validate claim files into the claims system for claim processing. Maintain Provider’s demographic records for accurate claim processing and claim payments. Reissue and void claim payments through third party payment processor software. Investigate and resolve errors with claim importing. Process claim repull requests from the Claims Department. Conduct reporting and ad hoc reporting on various processes within multiple systems. Utilize MWG Administrators Policy Administration System and Claims Management Software to verify eligibility and review member accounts based on the policy assigned. Input data into the MWG Claims Management Software. Perform other duties as assigned by the department manager. Have a comprehensive knowledge and clear understanding of MWGA business processes internally and externally.

EXPERIENCE AND EDUCATION REQUIREMENTS

High School Diploma or GED required; associate or bachelor’s degree is preferred. Must have 1-2 years of previous health insurance claims experience or health insurance billing experience. Must have excellent computer skills and have strong knowledge of Microsoft Outlook, Windows, Excel, and Word. Must possess time management, organizational, problem solving, and customer service skills. Must be able to work well under pressure with multiple priorities and meet deadlines. Must be able to multitask while maintaining attention to details.

WORKING ENVIRONMENT

Must be able to perform in a very high paced environment and professionally handle interruptions. Must have the ability to work under minimal supervision. Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines. Must possess excellent problem-solving skills and have keen attention to details. Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills. Must be able to handle stressful situations appropriately. Must maintain confidentiality and privacy in every aspect of the job.

JOB ESSENTIAL REQUIREMENTS

The following are job functions that an employee must be capable of performing with or without reasonable accommodation. Must be able to read, write, and speak English; Spanish is a plus. Must have basic typing skills Must be able to work as scheduled. Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met. Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday. Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.

REASONABLE ACCOMODATIONS

Morgan White Group will reasonably accommodate qualified individuals with a disability so that they can perform the essential functions of a job, unless doing so causes a direct threat to these individuals or others in the workplace and the threat cannot be eliminated by reasonable accommodation or if the accommodation creates an undue hardship for Morgan White Group.

EQUAL OPPORTUNITY EMPLOYER

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person’s qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.