Kforce New Provider Services in Maryland Heights, Missouri

Kforce has a client in Maryland Heights, MO that is searching for a good New Provider Services in the Healthcare Industry. This is a potential temp to hire role, (not certain).Essential Functions:

  • Works in a phone queue and provides assistance and coaching to CCAs when they require help in servicing a call; makes each encounter with a CCA a learning experience by helping guide the CCA to the answer or information they need to service their call to completion; contributes to a self-leadership environment through individual support and development of the CCAs; handles escalated member and provider calls directly when necessary

  • Handles special requests from Customers requiring manual work-arounds or specials projects; manages authorization exception reports, and interfaces with network and claims on authorization issues. Handles emails and faxes for designated Customers

  • Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers

  • Works with client specialists to assure that information in work flows is accurate and current, and that process flows meet customer needs

  • Educates Providers on system or process changes to support efficiency initiatives

  • Supports Appeals triage and claims appeals

  • Observes and tracks authorization problem trends and works with internal department for resolution

  • Assists with User Acceptance Testing (UAT) for designated Customer changes

  • Assists with silent monitoring or quality audits upon request

  • Participates in quality improvement initiatives and new product implementations

  • Backs up inbound/outbound queues when needed

  • May provide coverage for others as needed

  • Assume responsibility for self-development and career progression

  • Proactively seeks and participates in ongoing training

  • Not a call center role

  • Candidate will be completing forms for obtaining government security clearance and placing outbound calls

  • Candidates need to have sufficient computer literacy (Excel), and ability/willingness to complete forms and documents

  • Proficiency in Microsoft Office, particularly Excel

  • Candidate needs to possess excellent written and verbal communication

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.Compensation Type:HoursMinimum Compensation:15.00Maximum Compensation:16.00