Provider Services Lead at Magellan Health Services inc in Saint Louis, Missouri

Job Description:

This position works in an operations team that strives to provide first call resolution to a specified set of Customers. This position answers inbound calls to provide SBU Customer Care Associates I and II (CCAs) with coaching and support to ensure high quality and accurate information is provided to callers efficiently. In addition, this position is responsible for special workflows or manual processes in support of their Customers. This position researches complaints, and works with edit reports to assure acceptance by Health Plans claims system. This position is responsible for both inbound and outbound back-up and coverage support to assure customer and regulatory requirements are met.

• Works in a phone queue and provides assistance and coaching to Customer Care Associates 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 workaround 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.


• Provides coverage for others as needed.


• Assumes responsibility for self-development and career progression.


• Proactively seeks and participates in ongoing training.
  
  

Responsibilities
Knowledge of CPT coding.
Knowledge of end to end processes of Administrative Services Only (ASO) and Risk accounts.
Knowledge of customer service measures (ASA, abandonment rate, talk time).
Ability to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration.

General Job Information

Title
Provider Services Lead

Grade
19

Work Experience - Required
Customer Service

Work Experience - Preferred

Education - Required
GED, High School

Education - Preferred
Bachelors

License and Certifications - Required

License and Certifications - Preferred

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.