Provider Services Representative I

  • Irving, TX

Website Administrative

Reference Code: 4584

Position Title: Provider Services Representative I
Duration: 6 months contract with possible extension
Desired Start Date: 1/11/2021 – 7/10/2021
Location: REMOTE Irving, TX 75038


Comments for Suppliers: home health experience would be best.

-100% remote position, however we would prefer for candidates to be local to Irving, TX to qualify for the role
-The position requiring 1 year of experience with Managed Care, Medicaid product, Claims and STAR-PLUS experience. Familiar with computer and Windows PC applications (Microsoft Excel, Word, Outlook), includes the ability to navigate and learn new and company’s computer system applications. Communication and organizational skills to successfully engage high volume of workload.

Day to day responsibilities:
Response to electronic and direct inquiries from providers about claims, rates, authorizations, eligibility, credentialing, etc.
Work of projects/matters with internal counterparts.
Complete documentation necessary to track provider issues and facility reporting to senior leadership.
Deliver information and answer questions in a positive manner to facilitate strong relationships with providers. (great customer service skills)

Shift – 8am – 5pm CST


Provides support to the Provider Services Team in regards to receiving, researching and responding to provider inquiries.

Essential Functions:

  • Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.
  • Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to members.
  • Supports other members of the Provider Services Team when they are in the field.
  • Responsible for documenting requests as required in departmental procedures.
  • Assists with training of new Provider Services staff members.
  • Attends off-site meetings when necessary with medical groups and other providers as needed.
  • Complies with required workplace safety standards.


  • Decision-making skills based on documentation, fee schedules and contract terms
  • Extensive software skills & competencies, as well as Internet research abilities including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Access)
  • Ability to interact well with both internal and external customers
  • Ability to be organized and flexible
  • Good understanding of medical billing, and claims processing systems
  • Ability to multitask and work in a fast-paced team environment
  • Excellent organizational and verbal and written communication skills
  • Ability to abide by policies
  • Ability to maintain attendance to support required quality and quantity of work
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

Required Education: High School Diploma or equivalent GED

Required Experience: 0-2 years customer service, provider service, or claims experience in a managed care setting (Medical office experience may substitute for this).



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