• Provider Services Representative - Hybrid,…

    McLaren Health Care (Indianapolis, IN)


    We are looking for a Provider Service Representative, to join us in leading our organization forward.

     

    McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

     

    McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.

     

    As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

     

    McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at

     

    https://www.mclarenhealthplan.org

     

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    MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at

     

    https://www.mdwise.org/

     

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    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 Provider Relations to handle issues.

     

    Also responsible for assisting members with eligibility, benefit, and resolution of claims issues as needed.

     

    This is a hybrid position with requirements to come onsite as scheduled, Indianapolis, IN

     

    Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

    Qualifications:

    Required:

    + High School Diploma or equivalent certification

    + Two (2) years’ experience in a in a physician health care office environment or high-volume call center

    Preferred:

    + Associate 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).

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