Claims, Audit and Recovery
Provider Services Representative
Louisville , KY, United States

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely--62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We’re 12th on Forbes’ list of America’s Most Promising Companies for 2015, one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

This position is responsible for responding in a timely, professional and courteous manner to all provider and customer inquiries. This includes provider phone calls or correspondence regarding benefit, eligibility, and all other inquiries as well as identifying and responding to grievances and dissatisfaction. 

The Experience You Need (Required):

Principal Accountabilities:
• Services calls and correspondence from providers; identifies and/or responds to inquiries, dissatisfaction, and refers appropriate provider grievances to Special Support for Provider Services. Documents all calls in EXP documentation system. 
• Applies established protocols to ensure resolution is provided in a clear and accurate manner. 
• Facilitates problem resolution and acts as a customer advocate.
• Identifies provider/member issues and refers them to the appropriate department. 
• Follows up on outstanding inquiries and works with special support and supervisory staff to resolve any non-compliant issues. 
• Works to facilitate resolutions to member billing inquiries or other billing/claims issues. 
• Reviews phone activity and quality reports to self-monitor performance, quality and productivity standards. Discusses deficiencies/problems with Manager to adjust behavior and work activities as appropriate.
• Maintains a balance of quality, productivity and timeliness of all job responsibilities.
• Demonstrates a working commitment to aiding in fulfillment with all company operating goals. 
• Actively participates in any required training on as needed basis.
• Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company standards.
• Perform other duties and projects as assigned.
Key Competencies/Success Factors:
• Lives the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance appraisal.
• Excellent communication skills (verbal, written, and listening). 
• Investigative, decision-making, problem-solving, interpersonal, and organization skills required.
• Consistent demonstration of accuracy, thoroughness and timeliness in completing work assignments.
• Ability to work with both members and providers and provide accurate information to both customer bases.
• Adheres to stringent call center schedule including beginning work on time, keeps absences within guidelines, returns on time from breaks and meals, and displays flexibility when scheduling time off.
• Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system. 
• May be required to work overtime, weekends and holidays.
• May be required to work flexible work schedule based on business need.

Finishing Touches (Preferred):

Education, Training and Experience:

• Associate’s degree preferred. 
• 1 year customer service experience preferred.
• Prior experience in the Healthcare or Managed Care industry preferred.
• 1-3 years of experience as a Provider Services Representative or comparable experience preferred. 

Evolent Health is an Equal Opportunity/Affirmative Action Employer


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