To provide participating provider information to members' inquiries and to maintain & update PAI network providers' credentials & files and to ensure that they are providing services within the scope of their licenses and insurances.
Skills / Knowledge Requirements
• Excellent communication skills (both verbal and written)
• Excellent customer service and etiquette skills
• Type 45 WPM
• 10 key by touch
• Computer literate in Word, Excel & other Microsoft applications
• Strong organizational & multi-tasking skills
• Self-starter & quick learner
• Strong concentration, listening and problem-solving skills
• Knowledge of medical/drug coding & terminology a plus
• High school diploma or GED & (1) year customer servicing experience or equivalent
• Respond and follow-up to member/provider inquiries in a timely and professional manner. Communicate accurate membership, benefit and claims information in response to inquiries verbally or through written correspondence within established procedures. Elevate exceptional cases to supervisor.
• Identify specific questions, problems or concerns using clarifying questions and research of individual files when contact is initiated by member or providers
• Access, interpret and analyze information maintained on computer databases and in resource manuals that requires effective use of keyboard and PC screens.
• Update & maintain all credentials for all PAI network providers
• Update & maintain all provider contracts & correspondences in file and on system
• Ensure that all provider correspondences & contracts are mailed in an accurate & timely manner
• Assist supervisor in expanding the provider network throughout Hawaii
• Sort incoming mail for the department
• Knowledge of the benefits for designated Health & Welfare account(s).
• Generate reports to be used in maintaining accurate provider data in system
• Update provider directory periodically for website maintenance.
• Assist supervisor in researching credentialling guidelines & criteria
• Prepare & communicate all follow-ups & customer related issues to claim examiners to ensure appropriate resolution
• Assist with misc. H&W projects & tasks
• Assist Provider Services supervisor with Provider Service department duties
• Receptionist Relief as needed and assigned
• Job duties are subject to change at the discretion of the supervisor based on the department's workload.
• Lifting and carrying file boxes within the office
• Indoors, air-conditioned office.
• Monday to Friday, 8:00 AM – 4:00PM or 8:30 AM – 4:30 PM, 1 hour unpaid lunch
• The duties assigned will (may) involve situations that will (may) require over time
Do not contact this company in solicitation of any product or service.