DeKalb Health
Provider Relations Representative I / Job Req 923009472
DeKalb Health, Alameda, California, United States, 94501
Provider Relations Representative I / Job Req 923009472 (Finance)
Hybrid: Applicants must be a California resident as of their first day of employment.
Principal Responsibilities Under general supervision from the Provider Relations Call Center supervisor, the Provider Relations Representative I performs a variety of routine and semi‑routine tasks that require thorough knowledge of organizational policies and procedures. The role provides administrative and operational support for the Provider Services Department and may be eligible for promotion to a Provider Relations II position after 12 months of demonstrated proficiency.
Answer incoming provider calls, emails, and other requests for assistance promptly, meeting departmental performance targets and providing excellent customer service.
Assist providers with basic inquiries about claims, authorizations, benefits, and other issues in coordination with Medical Services, Member Services, Provider Dispute Resolution Unit, and Claims departments.
Document all calls and contacts as required by department standards.
Participate in scheduled department meetings and trainings.
Escalate complex issues per departmental standards and follow through with timely solutions.
Maintain provider portal access and issue‑resolution processes.
Manage departmental inboxes, voicemail inboxes, and other communications.
Maintain files, prepare schedules, compile reports, and process routine documents accurately and timely.
Make outgoing calls to providers as directed by departmental needs and initiatives.
Adapt to changes in benefits, workflow processes, and systems.
Collaborate with other departments to support continuous improvement of provider relations effectiveness.
Maintain strict confidentiality of all sensitive information and issues.
Participate in provider projects and coordinate processing of incoming and outgoing mail as needed.
Assist with data maintenance in various databases, print and distribute information on request, and support special projects.
Essential Functions of the Job
Respond to calls, emails, and assistance requests promptly, following performance targets and delivering excellent service.
Provide accurate health plan benefits, plan rules, reimbursement amounts, and validate provider data.
Resolve provider conflicts by coordinating with departmental staff.
Create and mail appropriate provider materials and communications as needed.
Participate in departmental and non‑departmental meetings and comply with the organization’s Code of Conduct, regulatory and contractual requirements, policies, procedures, and internal controls.
Physical Requirements Continuous desk work with constant use of visual focus, keyboard, mouse, and telephone headset. Frequent verbal and written communication. Frequent lifting of folders (0‑30 lbs), walking, and standing.
Minimum Qualifications
Two years of college or equivalent work experience.
Minimum one year of direct provider service experience.
Experience in customer service, claims payment, claims resolution, and/or provider service preferred.
Special Qualifications (Skills, Abilities, License)
Strong customer service background.
Excellent critical thinking and problem‑solving skills.
Proficient in Windows and Microsoft Office suite.
Effective verbal and written communication skills.
Ability to handle multiple projects simultaneously and balance priorities.
Strong interpersonal, communication, and listening skills.
Attention to detail, accuracy, and adaptability.
Ability to work effectively in a multidisciplinary company.
Willingness to undergo tuberculosis testing and provide proof of COVID‑19, influenza vaccinations, or exemptions per onboarding requirements.
Salary Range: $22.88 - $34.33 Hourly.
The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to employ the best‑qualified person for every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.
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Principal Responsibilities Under general supervision from the Provider Relations Call Center supervisor, the Provider Relations Representative I performs a variety of routine and semi‑routine tasks that require thorough knowledge of organizational policies and procedures. The role provides administrative and operational support for the Provider Services Department and may be eligible for promotion to a Provider Relations II position after 12 months of demonstrated proficiency.
Answer incoming provider calls, emails, and other requests for assistance promptly, meeting departmental performance targets and providing excellent customer service.
Assist providers with basic inquiries about claims, authorizations, benefits, and other issues in coordination with Medical Services, Member Services, Provider Dispute Resolution Unit, and Claims departments.
Document all calls and contacts as required by department standards.
Participate in scheduled department meetings and trainings.
Escalate complex issues per departmental standards and follow through with timely solutions.
Maintain provider portal access and issue‑resolution processes.
Manage departmental inboxes, voicemail inboxes, and other communications.
Maintain files, prepare schedules, compile reports, and process routine documents accurately and timely.
Make outgoing calls to providers as directed by departmental needs and initiatives.
Adapt to changes in benefits, workflow processes, and systems.
Collaborate with other departments to support continuous improvement of provider relations effectiveness.
Maintain strict confidentiality of all sensitive information and issues.
Participate in provider projects and coordinate processing of incoming and outgoing mail as needed.
Assist with data maintenance in various databases, print and distribute information on request, and support special projects.
Essential Functions of the Job
Respond to calls, emails, and assistance requests promptly, following performance targets and delivering excellent service.
Provide accurate health plan benefits, plan rules, reimbursement amounts, and validate provider data.
Resolve provider conflicts by coordinating with departmental staff.
Create and mail appropriate provider materials and communications as needed.
Participate in departmental and non‑departmental meetings and comply with the organization’s Code of Conduct, regulatory and contractual requirements, policies, procedures, and internal controls.
Physical Requirements Continuous desk work with constant use of visual focus, keyboard, mouse, and telephone headset. Frequent verbal and written communication. Frequent lifting of folders (0‑30 lbs), walking, and standing.
Minimum Qualifications
Two years of college or equivalent work experience.
Minimum one year of direct provider service experience.
Experience in customer service, claims payment, claims resolution, and/or provider service preferred.
Special Qualifications (Skills, Abilities, License)
Strong customer service background.
Excellent critical thinking and problem‑solving skills.
Proficient in Windows and Microsoft Office suite.
Effective verbal and written communication skills.
Ability to handle multiple projects simultaneously and balance priorities.
Strong interpersonal, communication, and listening skills.
Attention to detail, accuracy, and adaptability.
Ability to work effectively in a multidisciplinary company.
Willingness to undergo tuberculosis testing and provide proof of COVID‑19, influenza vaccinations, or exemptions per onboarding requirements.
Salary Range: $22.88 - $34.33 Hourly.
The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to employ the best‑qualified person for every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.
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