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McLaren Health Care Provider Services Rep in Flint, Michigan

Description

The position will be in Flint, Michigan or Indianapolis, Indiana.

McLaren Health Plan, a division of McLaren Health Care Corporation, is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Provider Service Representative to join in leading the organization forward.

McLaren Health Plan (MHP) is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP and its subsidiaries offer multiple product lines, including employer plans, individual and family plans, Medicaid and Medicare plans, to Michigan residents for every stage of life. The plan has earned the prestigious Pinnacle Award every year since 2013 from the Michigan Association of Health Plans and is also accredited by the National Committee for Quality Assurance (NCQA).

With a commitment to diversity and inclusion, a strong focus on improving the health of our members and a vision to provide the highest standards of quality and service, MHP is poised to meet the challenges of tomorrow.

Position Summary:

This position will be responsible for daily provider telephone calls which will include problem solving, eligibility, benefit, and resolution of claims issues. Assists in providing linkage to the Medical Management Department for authorization of services. Being an advocate for the Provider, supplying information and education, working with Network Development to handle issues. Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.

Qualifications

Required:

  • High School Diploma or equivalent certification.

  • Two (2) years’ experience in a high-volume call center.

  • Two (2) years’ experience in a Physician front office environment.

Preferred:

  • In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.

  • Associate’s Degree in business, health care or related field.

  • Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts).

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Job: Administrative/Clerical

Primary Location: Michigan-Flint-McLaren Health Plan Bldg

Employee Status Regular

Shift Day Job

Job Type Standard

Schedule Full-time

Req ID: 20009907

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