Provider Specialist Level I

Job title

Provider Specialist Level 1 

Position Summary

A Provider Specialist Level 1 will represent Provider Relations in an inbound call center setting. This role will require the Specialist to answer a variation of calls from the MedRisk Network’s Providers that will include questions, concerns, updates, complaints and Network Participation as well as work all inboxes and assist on Special Projects as needed.

Primary Duties & Responsibilities

• Receive inbound phone and Email requests from both in and out network Providers maintaining satisfaction by yielding primary level information and addressing day to day provider inquiries.
• During inbound calls, the Provider Specialist will educate providers regarding their network status, contractual obligations, credentialing status, rates, etc.
• Receive/Transfer internal calls from/to Scheduling, Patient Advocacy, Customer Support and Claims Inquiry departments.
• The Provider Specialist will thorough documentation of conversations communicated on inbound calls.
• Create Inquiry Logs for Provider Relations and Credentialing Specialists Team when cannot be resolved during the call.
• Maintain a robust partnership with providers while simultaneously providing a high level of customer service.
• Updating specific Provider Demographics where appropriate during an inbound call including but not limited to phone, fax, email and communication preference.
• The Provider Specialist will also be responsible for managing the Provider Relation’s inboxes including but not limited to email and fax inbox(es), to create Inquiry Logs for internal/external requests. In doing so, communicate and delegate the Provider’s requests to the appropriate departments.
• This position is also responsible for Portal Enrollment and any project as needed.
• Strictly adheres to all aspects MedRisk Confidentiality, Privacy and Security Standards Policies and Confidentiality Operating Procedures in performing work. Does not use or discuss MedRisk’s or customers’, providers’, trading partners’ or vendors’ commercially sensitive or privacy-related information, including “PHI” (personal health information) with anyone inside or outside of MedRisk except as needed to perform an assigned task.
• Consistently meet MedRisk Customer Support Service & Quality standards (call and Inquiry monitoring)
• Other Task assigned.

Qualifications and Skills

• Minimum of 3 years of call center experience with in-bound calls
• Ability to multi task in a fast paced environment
• Excellent communication, organizational, adaptability and problem solving skills.
• Documentation, listening and phone skills.
• Knowledge Retention
• Initiative and the ability to troubleshoot and resolve conflict.
• Basic computer skills including MS Word, Excel and Outlook.
• High degree of Customer Service Skills including empathy, emotional intelligence and patience.
• Ability to exercise discretion and professionalism in external communication
• Bilingual in English and Spanish, this is a plus not required.

Competencies (choose at least 4)

• Customer Focus
• Listening
• Integrity and Trust

• Action Oriented
• Functional/Technical Skills
• Ethics and Values
• Priority Setting

Working Conditions & Physical Requirements

The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.

While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.

Employee Statement of Understanding

I have read and understand the job description for my position. I am able to perform all the essential functions of this position.

I agree to comply with the corporate compliance policy and all laws, rules, regulations and standards of conduct relating to my position. As an employee, I understand my duty to report any suspected violations of the law or the standards to my immediate supervisor.

As an employee, I will strive to uphold the mission and vision of the organization. All employees are required to adhere to the values in all their interactions with customers and fellow employees.