::The Provider Service Representative is responsible for complete the credentialing and re-credentialing of the FHC network according to the FHC policies and procedures that meets state and federal regulatory requirements of ASES, CMS, URAC and NCQA, as well as with clients standards.Â Is responsible to maintain updated providerâ€™s information and properly configured in the different electronic systems, answering and managing phone calls from providers, give orientation and refer, if necessary, situations presented by the providers to the corresponding person or department, among other requirements directly related to the provider service.
Participate in the process of recruiting and contracting providers taking into consideration the network needs.
Provide information and orientation to the providers about credentialing and re-credentialing process, contracting status, claims status, among other information.
Educates the providers about correct billing, claims submission, covered benefits, among others.
Attend providerâ€™s complaints and referrals of internal and external clients.
Complete the credentialing and re-credentialing process, as assigned by the supervisor, in the established timeframes and in compliance with the policies and procedures.
Perform site visits to the providers for evaluation of the facility, general orientation, gathering documentation and for any other process related to provider services, as necessary.
Participate and conducts internal audits of provider files, as required.
Perform ongoing monitoring to verify information related of sanctions or exclusions, licensure limitations, and any other validation.
Answers the telephone in the companyâ€™s established time, with a clear and pleasant tone of voice, and with an appropriate language expression.
Shows appropriate communication skills, effective listening and management skills to deal with difficult clients.
Conducts telephone calls to gather necessary information.
Demonstrate knowledge when using the electronic platform and other technological applications available.
Participate in educational activities to providers in and outside FHC.
Applies in a consistent manner the policies and procedures that are pertinent to the Providers Department at FHC.
Complies with the guidelines and established criteria for the different processes.
Complies with the established quality parameters.
Available to travel to offices of providers, clients, or any other facility, as required.
Available for work after business hours and weekends