Provider support Specialist

Provider support Specialist at Russell Tobin Provider support Specialist at Russell Tobin in Lehi, Utah Posted in 2 days ago.

Type:

full-time

Job Description:

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Now Hiring:

Provider Support Specialist ???? ????

Location:

Lehi, UT (Hybrid - 2 days onsite) ????

Duration:

6+ Months (Potential extension) ????

Pay Rate:

$23.15/hr (W2) ????

Schedule:

Monday - Friday

JOB RESPONSIBILITIES

You will play a critical role in resolving complex provider inquiries, improving operational workflows, and influencing the overall provider experience through direct feedback and continuous process improvement. What You'll Do Serve as a primary liaison between healthcare providers and our client, delivering timely, accurate, and professional support via phone and provider portal messaging Build and maintain strong relationships with provider offices, fostering trust and long-term partnership Investigate and resolve complex provider inquiries related to: Claims submission, status, and adjudication Benefit and plan interpretation Member cost-sharing and billing questions Prior authorizations and coordination of benefits Appeals and overpayment recoupment Verify and communicate patient eligibility, coverage details, and accumulator balances Document all interactions thoroughly and accurately within internal systems Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution Identify trends in provider issues and escalate systemic problems for root cause analysis and resolution Contribute to the development and refinement of internal tools, workflows, and training materials Educate providers on self-service tools and best practices to improve efficiency and reduce friction Meet or exceed established Service Level Agreements (SLAs) for response and resolution times What Success Looks Like Providers receive clear, accurate, and timely resolutions with minimal follow-up High-quality documentation and strong attention to detail across all interactions Demonstrated ability to independently resolve complex and ambiguous issues Consistent identification of trends and proactive contributions to process improvements Positive feedback from providers and internal stakeholders Basic Qualifications 2+ years of experience in healthcare operations, provider support, or medical claims Strong understanding of claims adjudication, eligibility, and prior authorization processes Excellent written and verbal communication skills, with the ability to explain complex information clearly Highly organized with strong attention to detail and documentation accuracy Ability to manage multiple priorities in a fast-paced, high-volume environment Experience working independently in a remote or hybrid setting Familiarity with HIPAA and patient confidentiality requirements Proven problem-solving skills and ability to navigate ambiguity Preferred Qualifications Experience in provider-facing or B2B support roles within healthcare Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms Experience with contact center systems and case management tools (e.g., Assist) Understanding of common claim denial reasons and healthcare payment cycles Bachelor's degree in Healthcare Administration or a related field (or equivalent experience) Tools & Systems Experience with or ability to quickly learn: Provider portals and clearinghouses (e.g., Availity, Zelis) CRM or case management systems (e.g., Assist) Internal knowledge bases and documentation tools Work Environment This is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays per week. PrideGlobal and it's affiliates offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors. 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.