PROVIDER AND CLIENT SERVICES REPRESENTATIVE

The MSO Provider and Client Services Representative (PCSR) is responsible for providing general administrative support to the MSO Department and works in conjunction with the MSO Value Based Care Programs team.

This position is responsible for handling inquiries from providers, vendors, and clients in relation to NEMS MSO operations such as claims processing, utilization management, and value-based care improvement activities. The PCSR works on projects/assignments of limited complexity in a supporting role.

The MSO Network Provider and Client Services Representative is required to have excellent ability to communicate effectively with a variety of professionals, including physicians, administrators, other healthcare providers, and services agencies.

ESSENTIAL JOB FUNCTIONS:

• Responsible to provide primary support to MSO Utilization Management, and Claims main phone line, general mailbox, voicemails, faxes, and other administrative tasks
• Responsible to research and understand basic authorizations, claims, provider appeals, benefit coverage issues raised by physician practices and/or health plan partners, coordinate follow up activities for resolution.
• Responsible for coordinating investigation activities for member grievances; track progress and report results to contracted Health Plan(s) within required timeframe.
• Assist the Value Based Care Programs team with outreach phone calls and other patient care improvement activities.
• Thoroughly and efficiently respond to all emails and/or voicemails that require any action in a timely manner.
• Complete other administrative and clerical tasks as assigned.
• Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:

• BA/BS Degree is preferred.
• One-year experience working in healthcare setting is preferred.
• Must have excellent communication skills (verbal and written), ability to communicate effectively with a variety of professionals, including physicians and other healthcare providers, business administrators and other healthcare services agencies.
• Must be PC literate - Strong Excel, Word, Power point, and Outlook skills.
• Detail-oriented and organized with the ability to interpret policy and make decisions.
• Good organization and problem-solving skills.
• Ability to self-manage and work with multiple departments within the organization and external clients.
• Knowledge of managed care and Medicare/Medi-Cal program is strongly preferred.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluent in Chinese (Cantonese and/or Mandarin) preferred
• Fluency in other languages is an asset.

STATUS:

• This is an FLSA Non-exempt position.
• This is not an OSHA high-risk position.