Job Details

Description

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

Duties

•  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
•  Filing

Other Duties

•  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.

Physical Demands

•  Lifting and carrying file boxes within the office

Working Conditions

•  Indoors, air-conditioned office.

Work Shift

•  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