PROVIDER AND CLIENT SERVICES… at North East… · Burlingame

Summary: North East Medical Services is seeking a Provider and Client Services Representative to provide administrative support within their MSO Department. The role involves handling inquiries related to claims processing and value-based care, while also coordinating member grievances and supporting the Value Based Care Programs team.

Responsibilities:
- Responsible to provide primary support to MSO Utilization Management, and Claims main phone line, general mailbox, voicemails, faxes, and other administrative tasks
- Responsible to research and understand basic authorizations, claims, provider appeals, benefit coverage issues raised by physician practices and/or health plan partners, coordinate follow up activities for resolution
- Responsible for coordinating investigation activities for member grievances; track progress and report results to contracted Health Plan(s) within required timeframe
- Assist the Value Based Care Programs team with outreach phone calls and other patient care improvement activities
- Thoroughly and efficiently respond to all emails and/or voicemails that require any action in a timely manner
- Complete other administrative and clerical tasks as assigned
- Performs other job duties as required by manager/supervisor

Required Qualifications:
- Must have excellent communication skills (verbal and written), ability to communicate effectively with a variety of professionals, including physicians and other healthcare providers, business administrators and other healthcare services agencies
- Must be PC literate - Strong Excel, Word, Power point, and Outlook skills
- Detail-oriented and organized with the ability to interpret policy and make decisions
- Good organization and problem-solving skills
- Ability to self-manage and work with multiple departments within the organization and external clients
- Must be able to fluently speak, read and write English

Preferred Qualifications:
- BA/BS Degree is preferred
- One-year experience working in healthcare setting is preferred
- Knowledge of managed care and Medicare/Medi-Cal program is strongly preferred
- Fluent in Chinese (Cantonese and/or Mandarin) preferred
- Fluency in other languages is an asset

Required Skills: Claims processing, Utilization management, Value-based care, Healthcare provider communication, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Outlook, Managed care knowledge, Medicare program knowledge, Medi-Cal program knowledge, Chinese language Cantonese, Chinese language /, Chinese language Mandarin