**Primary City/State:** Arizona, Arizona **Department Name:** Provider Relations **Work Shift:** Day **Job Category:** Marketing and Communications A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. If you’re looking to leverage your abilities – you belong at Banner. Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. As a Provider Experience Representative, you will be working in a remote setting. **Your work shifts will be Monday-Friday within the hours of 8:00 a.m-5:00 p.m. Arizona Time Zone.** If this role sounds like the one for you, Apply Today! Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position provides expertise through daily customer service to physicians and/or staff of Banner Health Network affiliated and non-affiliated providers. The representatives providing customer service to providers serves as a primary resource in complex and/or sensitive cases and other resources necessary to ensure an excellent quality of service. May be assigned to work in a variety of administrative duties relative to supporting the provider community. CORE FUNCTIONS 1. Receives, documents, researches and responds to provider inquiries and escalated calls following established policies and procedures and compliance guidelines. (Answer, identify, research, document, and respond to a diverse and high volume of inbound and outbound health insurance provider related calls on a daily basis.) 2. Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department’s ongoing goals and objectives. 3. Provides timely and accurate information to providers regarding claims, benefits, member out-of-pocket expenses, and payments via telephone or in writing. Verifies adjudicate claim payments independently and in accordance with plan guidelines. Performs analysis and appropriate follow-up while working with many individuals to acquire necessary materials and information, including, but not limited to: physicians, facility staff, professional staff and physicians’ office staff. 4. Identifies and resolves managed care issues concerning claims, contract interpretation, utilization management, eligibility and general operational issues. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms. 5. Assists internal departments in resolving provider appeals pertaining to the organization’s physicians, hospitals, and insurance plan contracts. Provides education to physicians and their office staff, hospitals and the organization’s insurance plan administration staff. 6. Works on special projects as assigned. 7. Services inbound and outbound providers and office staff communications for all facilities and/or physician offices in the states in which they operate. Works under limited supervision with various departments and staff to provide for diverse customer service needs for a comprehensive provider network. Makes decisions within structured definitions and defined policy. Work requires the constant exercise of a high degree of independent judgment in response to complex and sensitive provider issues, decision making and discretion. Handles physician inquires and problems within the scope of the job function and keeps supervisors apprised of all issues they occur. Meet quality, quantity, and timeliness standards to achieve individual department performance goals as defined within the department guidelines and compliance standards. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities, and is expected to accomplish all tasks with minimal supervision and instruction. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Must have substantial previous related work experience in healthcare services, with three to four years of experience in a high volume service center or managed care environment. Ability to multitask between inbound calls, searching the database or resource tools for correct and timely information, and maintain a professional demeanor at all times. Must have excellent communication skills, both verbal and written, while maintaining a positive and helpful attitude with customers. Must demonstrate an ability to meet deadlines in a multi-functional task environment. Requires excellent organizational skills and operational knowledge working with work processing, spreadsheets, data entry, fax machines, and other computer related skills. Must have the ability to acquire and utilize a sound knowledge of the company’s provider information systems, as well as, fundamental knowledge of the organization’s expectations. Must, at all times, maintain efficiency and timeliness in all daily activities. Must be able to establish daily work priorities and work efficiently to contribute to the successful overall provider experience. PREFERRED QUALIFICATIONS Experience with a strong knowledge of business and/or healthcare as normally obtained through the completion of an associate’s degree. The knowledge of medical claims typically acquired over one to two years of work experience in medical claims adjudication, contract interpretations, billing and coding, and medical terminology. Additional related education and/or experience preferred. **EEO Statement:** EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo) Our organization supports a drug-free work environment. **Privacy Policy:** Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy) EOE/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability