Provider Service Representative

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Provider Services Representative shall assume full responsibility and ownership for all aspects regarding education of the providers, practitioners, facilities, adjunct/ancillary and all other providers regarding the proper utilization of the Plan. In addition, the representative will address and resolve service related issues including appeals and complaints, eligibility determination and claims related issues for all product lines based on specified guidelines and timeframes while advising the customer of their rights and responsibilities. Additionally, the representative will assist with provider web inquiries, contract, pricing and fee schedule determinations. The Provider Service Representative will work closely with all departments such as Member Services, Claims Operations, Network Operations, Health Care Network Strategy, Provider Relations, Configuration and Membership and Billing to resolve provider inquiries as defined within Provider Services Procedures. The Provider Service Representative will also respond to inquiries received via written correspondence or by telephone call.

QUALIFICATIONS:

• High School diploma or GED with 2 years customer relations experience required, Associates Degree preferred.
• A background in health insurance claims and appeal processing is preferred.
• Additional experience in provider/practitioner billing and claim follow up preferred.
• Working knowledge of Microsoft Office applications is required. Experience with a documentation system to track inquiries generated and received preferred.
• Demonstrated ability to determine, analyze and solve problems related to benefits, claims appeals, claims pricing/processing by utilizing all applicable tools to make determinations is required. Demonstrated ability to successfully apply problem solving and time management methodology, balance multiple tasks as business needs arise while maintaining production and quality standards is required.
• Ability to interpret contract language related to all CDPHP's health plans to include riders and schedules to make eligibility determinations and verifications based on State statutes relating to healthcare administration and corporate guidelines.
• Demonstrated ability to effectively communicate on a verbal and written basis with providers and other persons associated with CDPHP while maintaining a professional approach is required.
• Demonstrated Ability to maintain a positive, professional demeanor. Ability to think creatively and participate in process improvement discussions as needed.

Hourly salary rate: $20.00/hour

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.

CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits here.