Provider Specialist (Healthcare)

Core Functions:

The provider specialist will be responsible for the full range of provider relations and service interactions for their assigned team. Function as a liaison for external Provider audit questions, claim reimbursement progress, assist in guiding Providers to portal ease of use and future service enhancements, training and education related to claim audit record submission, timelines, and processes.

Essential Duties & Responsibilities
 

• Work with an established group of providers.
• Assist with status updates.
• Claims questions
• Assist with guidance in healthcare audit process.
• Provide great customer service and establish productive working relationships.
• Attend meetings as deemed necessary.
• Up to 5% of annual travel required.

Required Qualifications

• 5+ years’ work experience in healthcare claims processing with in-depth experience with payor systems and their processes.

• Demonstrated results in a work environment where identifying, researching, and solving problems is required to be successful in the position.
• SME on how all types of healthcare claims pay with the ability to identify where things could/did go wrong and solve the issues.
• Strong knowledge of healthcare data and processes – knows the acronyms and what they mean to the overall process and has worked through solving problems related to that data.
• Knowledge of a variety of healthcare payment methodologies.

Preferred Requirements

• Bachelor’s degree in healthcare administration or related field of study.

• Diverse background knowledge of healthcare claims inpatient, outpatient and professional experience preferred.

Professional Requirements

• Effective communication skills (verbal and written) with ability to communicate with all levels of employees and international staff.

• Strong analytic and critical thinking skills.
• Excellent research skills.
• Able to multitask and keep track of details.

Working Conditions Physical & Mental Demands

• Sitting for extended periods of time while working on a computer/laptop.
• Visual requirements
• Dexterity requirements include regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); ability to use various writing tools (note taking); ability to operate a computer keyboard / mouse and other office equipment required for this position.
• Hearing and speaking requirements include the ability to hear normal speech, hear and talk to exchange information in person and over the cellphone / telephone sometimes using earphone headsets.
• Flexibility to remotely work varied shifts and hours to meet business needs.
• Communicating verbally and in written English language to meet business needs.
• Managing difficult conversations with determinations of requests and notifications to clients / providers and members of your Team.

Acknowledgement:

Contents of the job description is not restricted from change. EXL Health Management retains the right to assign, re-assign duties and responsibilities at any time to meet the business obligations and expectations.

What We Offer

EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions.

From your very first day, you get an opportunity to work closely with experienced, world-class Healthcare consultants.

You can expect to learn about many aspects of businesses that our clients engage in. You will also learn effective teamwork and time management skills - key aspects for personal and professional growth.

We provide guidance/ coaching to every employee through our mentoring program where in every junior level employee is assigned a senior level professional as advisors.

Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.