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Role Description

American Specialty Health Incorporated (ASH) is seeking a Provider Relations Representative to join our Provider Relations department. The primary purpose of this position is to respond to practitioner inquiries via the telephone queue system regarding credentialing, re-credentialing, and contracting to ensure efficient and effective resolution of practitioner inquiries or complaints and to deliver high-quality customer service. Additional duties will include other administrative tasks related to credentialing, re-credentialing, and contracting as assigned.

Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you to have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum 50 Mbps download and 50 Mbps upload speed.)

Responsibilities

• Respond to and resolve practitioner inquiries received via the Provider Relations and Credentialing queue.
• Assist practitioners, staff, and clients with questions regarding credentialing, re-credentialing, participation requirements, contractual issues, and high-level administrative problems.
• Perform credentialing and re-credentialing activities according to plan specifications.
• Forward complex requests that require research to the appropriate ASHCore bucket or PRL supervisor to achieve appropriate resolution.
• Capture practitioner complaints and resolve or forward to the appropriate ASHCore bucket or PRL supervisor for resolution.
• Capture practitioner change information, document, and forward as required to record changes in appropriate databases.
• Handle necessary administrative duties to properly support, document, and resolve practitioner inquiries.
• Maintain confidentiality of practitioner files, participation data, practitioner records/documents, and all discussions relative to recruiting, contracting, and credentialing processes.
• Attend department and all-staff meetings to increase knowledge and foster teamwork.
• Complete administrative tasks assigned.
• Pull CAQH applications when provider calls in with CAQH number. Drop application in designated folder.
• Download CAQH applications for PTOT practitioners that are being added to a provider.
• Perform other duties as assigned.
• Comply with all policies and standards.

Qualifications

• High School Diploma or GED certificate required.
• 2 years of progressive experience performing customer service duties preferred.
• Specialty health care or health care experience preferred.
• Credentialing and re-credentialing experience preferred.
• Proficient in MS Office with experience in word processing and spreadsheet applications.
• General understanding of Provider Relations Guidelines.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task, and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects.
• Ability to communicate both in verbal and written form.
• Ability to travel within and around the facility or Work from Home (WFH) environment.
• Capable of using a telephone, computer keyboard, and mouse.
• Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

Company Description

American Specialty Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.