Team Members are eligible to apply for a transfer or promotion after successfully completing their six-month introductory period AND have no open/active performance improvement plan (PIP). In addition, Team Members must meet the minimum requirements of the position for which they are applying. Member Services Representatives and Registered Nurses must complete one year of service in their current role as well as the requirements above.
Under the general direction of the Provider Call Center Supervisor, the Provider Call Center Representative is responsible for responding to Provider calls in a friendly, professional manner. The Provider Call Center Representative must be able to utilize all policies and resources to answer questions and direct Providers in order to resolve their concerns. Major Functions (Duties and Responsibilities)
1. Act as a Provider Advocate.
2. Communicate with contracted and non-contracted Providers by providing information and assistance as appropriate.
3. Assist Providers with interpreting Member eligibility and benefit information for any and all IEHP lines of business.
4. Assist with general question about the IEHP Programs and Member benefits.
5. Assist with direction on the IEHP Provider portal, including how to set up accounts, troubleshooting and navigating the website, how to submit and retrieve necessary information.
6. Handle claim status inquiries, researching and facilitating resolution of payment issues; provider education on remittance advice interpretation and reimbursement, and informing providers of the IEHP claims appeals process.
7. Work closely with the Claims Team in resolving claims discrepancies, inappropriate denials and delays in payments.
8. Provide IEHP Vision providers with eligibility; process authorizations and Vision Exception Requests (VERs).
9. Answer questions regarding UM authorizations and denials. Make appropriate changes to authorizations and transfer calls to UM for clinical inquiries Educate providers on IEHP Referral process.
10. Assist Behavioral Health (BH) Providers with questions on benefits and guide BH Providers through the Provider portal in submitting online forms.
11. Work closely with Finance Team on possible overpayments and to request assistance with payment verification, including the voiding and reissue of checks, updates to W-9 changes.
12. Meet IEHP and Provide Services Call Center Standard Work and performance expectations. This includes, but is not limited to the following:
a. Successful completion of 6-week Provider Call Center training
b. Active participation in continuous training
c. Use telephone system and other IEHP equipment appropriately and for professional reasons only
d. Follow required call scripts and QA requirements
e. Ability to handle high call volume
f. Strict adherence to specific work schedule and IEHP Attendance and Punctuality Policy
g. Participate in Provider Call Center meetings, which are held approximately twice a month from 7:00am to 8:00am
h. Maintain standards for Provider and Member Rights and Responsibilities, such as maintaining Provider and Member confidentiality
i. Document timely and accurate of all calls received. Over 100% call documentation is required
13. Provide excellent customer service to all callers. Demonstrate a high level of patience and respect with every caller, avoid distractions (reading non-work related materials, using cell phones or other non-work related electronic devices), ensuring each caller is assisted promptly and appropriately and follow Provider Call Center established call handle Quality Assurance Standards and Objectives
14. Extensive knowledge of all IEHP product lines (Medi-Cal, DualChoice, and Healthy Kids) and ability to transfer knowledge to all callers’ inquiries.
15. Assist the Provider Call Center or Provider Services Departments with projects, as needed.
16. Timely follow up with Providers on cases as needed. Supervisory Responsibilities Leading: Self Experience Qualifications
Six (6) months customer service experience with prior experience in handling problems and complaints with a high level of patience. Experience in learning and following standards and procedures. Microsoft Windows applications experience. Preferred Experience
Medi-Cal program and benefit requirements experience desired. HMO or Managed Care Experience preferred. A minimum of 1 year call center experience in a customer services setting preferred. May substitute with 2 years of experience in a medical or hospitality setting. Education Qualifications
High school diploma or GED required Drivers License Required No Knowledge Requirement
One (1) year knowledge of medical groups/HMO/IPA operations, in a managed care setting preferred. Understanding of and sensitivity to multi-cultural community. Skills Requirement
Excellent customer service skills. Excellent written and verbal communication and interpersonal skills. Strong organizational skills, typing 35 words per minute, skilled data input, and sound decision making skills required. Ability to analyze complex claims data/payments and clearly communicate findings to Providers. Abilities Requirement
Ability to diffuse difficult situations. High technological aptitude with easy adaptability to diverse conditions, and troubleshooting. Ability to establish and maintain effective working relationships with others. Must be detailed-oriented. Telephone courtesy. High degree of patience. Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Physical Requirements Hearing: One-on-One – FREQUENTLY Keyboarding: Traditional – FREQUENTLY Keyboarding: Touch-Screen – FREQUENTLY Keyboarding: 10-Key – FREQUENTLY Communicate: Information/ideas verbally – FREQUENTLY Regular contacts: co-workers, supervisor – FREQUENTLY Near Visual Acuity – FREQUENTLY Indoors – FREQUENTLY Sitting – CONSTANTLY Lighting – CONSTANTLY Memory – FREQUENTLY Understand and follow direction – FREQUENTLY Regular and reliable attendance – CONSTANTLY
Starting Salary: $45,884.80 – $55,993.60
Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.