Title: Provider Relations Associate Analyst
Location: Remote
Duration:6 Months
Work Schedule: After all of the training is completed, the hours for this position will be 10:30 AM - 7:00 PM CST.
Training Hours: Monday through Friday, 8:30 AM - 5:00 PM CST.
 
Screening Questions (we need your experience write-up)

• What kind of exposure/experience do you have in the behavioral health field?
• What kind of experience do you have with customer service?
• Do you have a Bachelor’s Degree in Behavioral Health? (please check the specific requirements)
• If the opportunity were to present itself, would you be interested in a full-time position with Client?

 
Please Note:

• This position is fully remote/work from home. At this time, candidates must be willing to complete all training and work from their home. Client will supply all equipment; however, a high-speed internet connection is required.
• Candidates must have a reliable high-speed internet connection at home — this will NOT be provided.
• The manager is seeking candidates located anywhere in the U.S. Candidates located in PST or MST are ideal to staff our late shift.

Job Description and Role Summary:

• The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues.
• Types of calls a Claims & PR Advocate may handle include but are not limited to: Inquiries about claim status details, Claim reprocessing requests and Provider contract questions or requests to update demographics.
• Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications may be needed within the same call.
• Independent problem-solving, multitasking, and technical savvy are essential.
• Calls must be serviced in a helpful and professional manner.

Responsibilities:

• Answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
• Work in a structured environment, spending most of the day answering calls from a queue.
• Occasional outbound calls may be necessary for issues requiring follow-up.
• Assist a member or provider with understanding how a claim has processed.
• Verify claim status for a member or provider.
• Educate a member or provider on billing protocols.
• Write or correct authorizations to ensure claims are paid correctly.
• Send claims for adjustment/reprocessing.
• Request duplicate EOBs for a member or provider.
• Send a request for a cancelled check copy, reissue a check, or request a stop pay/do not reissue on a check.
• Provide follow-up on issues by making outbound calls when necessary.
• Send resources to members and providers via email.
• Submit a complaint on the member or provider's behalf.
• Send handoff requests to matrix partners for escalated or complex issues.
• Assist providers with contract-related inquiries and demographic updates.
• Independently problem-solve to ensure accurate information is provided, exceptional customer service is delivered, and first-call resolution is achieved.

Skills:

• Customer service experience.
• Ability to excel in a virtual team environment.
• Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.
• Superb interpersonal communication skills.
• Effective listening and organizational skills, with the ability to manage multiple tasks.
• Intuitive technical capabilities with the ability to quickly understand and apply working knowledge of several claim systems and applications.
• Independent problem-solving skills.
• Strong time management skills.
• Ability to type effectively and have strong PC skills.

Attendance Policy:
Maintaining good attendance is crucial for all contractors, particularly for those newly hired.
The Corrective Action process for a contractor who incurs an unscheduled or unapproved absence or event within the first 90 days of the assignment is outlined below:

• 1st unapproved absence/event: Verbal Counseling
• 2nd unapproved absence/event: First Notice
• 3rd unapproved absence/event: Final Notice
• 4th unapproved absence/event: Termination

Late Arrivals/Early Departures:
Late arrivals and early departures without appropriate notifications count toward an unscheduled, unapproved absence. Based on business need, a manager may allow a contractor to make up the time during the business day. However, this does not excuse the behavior.Recording of Late Arrivals:

• 7 minutes to 15 minutes: Recorded as an occurrence.
• 15 minutes to 30 minutes: Recorded as an occurrence. Time may be made up on the same day at the manager's discretion.
• 30 minutes or more: Recorded as an occurrence and time will be recorded as unscheduled time off. No portion of this time can be made up.
  Any exceptions will be determined by the supervisors.

If attendance issues become excessive or a trend develops that negatively impacts productivity, performance, or contribution, management may accelerate the corrective action process.
 
 
 
  

About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $19.00/hr.