Role Description American Specialty Health Incorporated (ASH) is seeking a Provider Relations Representative to join our Provider Relations department. The primary purpose of this position is to respond to practitioner inquiries via the telephone queue system regarding credentialing, re-credentialing, and contracting to ensure efficient and effective resolution of practitioner inquiries or complaints and to deliver high-quality customer service. Additional duties will include other administrative tasks related to credentialing, re-credentialing, and contracting as assigned. Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings. Responsibilities - Respond to and resolve practitioner inquiries received via the Provider Relations and Credentialing queue. - Assist practitioners, staff, and clients with questions regarding credentialing, re-credentialing, participation requirements, contractual issues, and high-level administrative problems. - Perform credentialing and re-credentialing activities according to plan specifications. - Forward complex requests that require research to the appropriate ASHCore bucket or PRL supervisor to achieve appropriate resolution. - Capture practitioner complaints and resolve or forward to the appropriate ASHCore bucket or PRL supervisor for resolution. - Capture practitioner change information, document, and forward as required to record changes in appropriate databases. - Handle necessary administrative duties to properly support, document, and resolve practitioner inquiries. - Maintain confidentiality of practitioner files, participation data, practitioner records/documents, and all discussions relative to recruiting, contracting, and credentialing processes. - Attend department and all-staff meetings to increase knowledge and foster teamwork. - Complete administrative tasks assigned. - Pull CAQH applications when provider calls in with CAQH number. Drop application in designated folder. - Download CAQH applications for PTOT practitioners that are being added to a provider. - Perform other duties as assigned. - Comply with all policies and standards. Qualifications - High School Diploma or GED certificate required. - 2 years of progressive experience performing customer service duties preferred. - Specialty health care or health care experience preferred. - Credentialing and re-credentialing experience preferred. - Proficient in MS Office with experience in word processing and spreadsheet applications. - General understanding of Provider Relations Guidelines. Core Competencies - Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships. - Ability to display excellent customer service to meet the needs and expectations of both internal and external customers. - Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment. - Ability to effectively organize, prioritize, multi-task, and manage time. - Demonstrated accuracy and productivity in a changing environment with constant interruptions. - Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions. - Ability to exercise strict confidentiality in all matters. Mobility - Primarily sedentary, able to sit for long periods of time. Physical Requirements - Ability to see, speak, and hear other personnel and/or objects. - Ability to communicate both in verbal and written form. - Ability to travel within and around the facility or Work from Home (WFH) environment. - Capable of using a telephone, computer keyboard, and mouse. - Ability to lift up to 10 lbs. Environmental Conditions - Work-from-home (WFH) environment. Company Description American Specialty Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

Role Description At Virtua Health, we exist for one reason – to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between – we are your partner in health devoted to building a healthier community. This position is responsible for: - Experience in a fast-paced call center environment strongly preferred, Epic experience a bonus. - Administratively coordinates and monitors the patient throughout the patient experience including scheduling of appropriate appointments, documentation, and insurance coordination in a fast-paced, busy Virtual Call Center Environment setting. - Providing concierge-like service and access as the first-line administrative contact for patients. - Meeting departmental goals to reach company customer service goals. - Working closely with clinical staff in coordinating and scheduling appointments. - Providing professional customer service to patients. - Making and scheduling future patient appointments and performing a variety of tasks related to the scheduling of clients to receive services ordered by medical service providers. - Preparing task logs of daily activity as requested by management. - Assisting with logistical and/or clerical problem resolution related to the patient’s appointments. - Following protocols as outlined by management. Qualifications - High school diploma or GED. - Previous medical clerical experience. - Understanding of medical terminology. - Experience working with Navinet, ECW, EPIC. - Experience working in a multispecialty group practice or healthcare system preferred. - One year experience in insurance authorizations desirable. Requirements - Assists patients by determining needs, scheduling or canceling appointments, or referring to correct staff person. - Provides professional customer service by obtaining and verifying necessary demographic and insurance information. - Maintains and updates current information on physician schedules ensuring that patients are scheduled properly. - Obtains and enters new patient demographics; updates patient information, as necessary, in the computer system to maintain accuracy for front desk & billing. - Obtains insurance information and documentation. - Accurately documents patient accounts of all actions taken. - Monitors and/or performs daily administrative coordination of patient experience through scheduling of administrative appointments. - Enters data and documentation in patient health database, as well as practice logs. - Provides administrative support to clinical team as needed regarding correspondence, patient record, and documentation. - Interacts professionally with other employees, customers, and suppliers. - Works effectively as a team contributor on all assignments. - Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and management. - Maintains strictest confidentiality; adhering to all HIPAA guidelines/regulations. - Maintains regular and punctual attendance. - Completes additional projects and duties as assigned by manager. Benefits - Medical/prescription, dental and vision insurance. - Health and dependent care flexible spending accounts. - 403(b) (401(k) subject to collective bargaining agreement). - Paid time off. - Paid sick leave as provided under state and local paid sick leave laws. - Short-term disability and optional long-term disability. - Colleague and dependent life insurance and supplemental life and AD&D insurance. - Tuition assistance. - Employee assistance program that includes free counseling sessions.

Role Description - Initiates phone calls to customers (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings and to request action. - Provides timely response and resolution for all provider initiated inquiries (phone calls, emails or faxes). - Reviews and analyzes documentation and claim data to determine validity and proper action. - Updates accounts receivable system with denial and group information. - Assists with high priority special projects. - Performs other functions as assigned. Qualifications - High school diploma, GED, or equivalent work experience. - 2+ years’ experience as an examiner/processor with exposure to medical terminology and claim processing experience in Commercial Insurance or Government Programs required. - 2+ years previous experience in a claims customer service environment OR 2+ years of answering inbound calls regarding claims processing. - Ability to work proficiently with Microsoft Word. - Ability to multi-task and prioritize. - Ability to be careful and thorough about detail. - Ability to organize well. - Primarily sedentary work remotely. - Ability to communicate and exchange information. - Ability to comprehend and interpret documents and data. Requirements - Mental Requirements: - Communicating with others to exchange information. - Assessing the accuracy, neatness, and thoroughness of the work assigned. - Physical Requirements and Working Conditions: - Remaining in a stationary position, often standing or sitting for prolonged periods. - Repeating motions that may include the wrists, hands, and/or fingers. - Must be able to provide a dedicated, secure work area. - Must be able to provide high-speed internet access/connectivity and office setup and maintenance. - No adverse environmental conditions are expected. Benefits - Base compensation ranges from $17.50 to $19.50 per hour. - Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. - This role is eligible for discretionary bonus consideration. - Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. - Cotiviti offers a competitive benefits package including: - Medical, dental, vision, disability, and life insurance coverage. - 401(k) savings plans. - Paid family leave. - 9 paid holidays per year. - 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

Role Description The role involves handling incoming calls from patients and business office team members to perform coverage updates. Key responsibilities include: - Updating information in the Electronic Health Record(s) (EHR) to ensure coverage is verified and accurate. - Initiating claims on affected transactions. - Performing updates based on Visit Filing Order changes daily. - Reviewing electronic eligibility transactions for patients with upcoming services and for services already billed. - Sending and receiving Customer Relationship Management requests (CRM) for communication regarding patient-initiated insurance concerns. - Following up on patient-initiated insurance changes through the EHR Patient Portal. - Updating guarantor accounts based on patient-initiated requests. - Updating hospital account records (HARs) and visits to correct data discrepancies. - Working on other EHR workqueues related to patient demographic, guarantor, and coverage information as needed. Qualifications - High School Graduate. - Typically requires 2 years of experience in health care, focusing on registration, insurance, and billing. - Knowledge and understanding of Revenue Cycle-specific insurance and billing procedures preferred. - Previous data entry experience with emphasis on speed and accuracy. - Good organizational ability and solid written and verbal communication skills. - A basic understanding of EHRs, with the ability to gain deeper knowledge. - Knowledge of Medicare, Medicaid, and third-party payors. - Knowledge of medical terminology. Requirements - Must be able to sit most of the workday. - Must be able to lift up to 10 lbs. occasionally. - Operates all equipment necessary to perform the job. - Exposed to a normal office or home office environment. Benefits - Base compensation within the listed pay range based on qualifications, skills, relevant experience, and/or training. - Premium pay such as shift, on call, and more based on a teammate's job. - Incentive pay for select positions. - Opportunity for annual increases based on performance. - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program.