Provider Services Representative, Michigan
Flint, MI
Posted 2 months ago
Job Description
McLaren Health Plan (MHP) is a company with culture of high performance and a mission to help people live healthier, more satisfying lives. We are looking for a Provider Services Representative to join us in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offer multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary: This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, and working with Provider Relations to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.
- High School Diploma or equivalent certification.
- Two (2) years' experience in a physician health care office environment or high-volume call center.
- Associate degree in business, health care, or related field.
- Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO, and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements, and actuarial precepts).
- In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
- Schedule: Full-time
- Requisition ID: 26003821
- Daily Work Times: 9:30 am - 6:00 pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No
McLaren Health Care
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 28,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.As part of its Graduate Medical Education (GME) program, McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Medical University. McLaren’s seven (7) GME campuses offer 27 residencies and eight (8) fellowship programs that train over 650 future physicians annually. All GME programs at McLaren are overseen and managed centrally by the Department of Academic Affairs.
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