Provider Services Representative
Posted on: August 7, 2022
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PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion,
color, national origin, sex, sexual orientation, gender identity or
Diversity and Inclusion: PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual
differences are appreciated, respected and responded to in ways
that fully develop and utilize each person's talents and
Position Overview: Maintain positive public relations with provider
groups, hospitals and clinic administrators across all business
lines. Act as a personal contact for training, materials
distribution, and as an information resource. Work throughout the
PacificSource service area to educate provider office staff on
current coding and PacificSource administrative and claims
procedures. Act as a leading resource for cross functional, complex
problem-solving within the Provider Network Department.
* Visit provider groups for on-site service calls to update office
staff on PacificSource products, administrative and claims
procedures, and current coding issues pertaining to all business
* Visit newly contracted providers within eight weeks of contract
* Work to resolve potential problems before they become an issue
with the provider groups and work to ensure satisfaction with
* Distribute a variety of claims analysis reports and other
information pertaining to the provider's practice.
* Provide follow-up on behalf of Customer Service and other
PacificSource departments regarding participating providers'
contract questions or compliance issues across all business
* Act as a liaison for PacificSource between provider groups,
PacificSource members, and PacificSource to resolve problems and
comply with requests.
* Communicate with provider offices and their staffs, PacificSource
departments, PacificSource Special Investigations Unit, and
Provider Network Contract Account Lead.
* Document problems, issues, and resolution in provider files or
call tracking as needed.
* Help ensure maintenance and accuracy of the Provider Manual.
* Thoroughly explain the Provider Manual, provider contract, member
plan information, and other information during on-site service
calls and as needed, drawing on extensive knowledge of materials
* Review documents before delivery to ensure accuracy.
* May assemble materials and other collateral information prior to
* Demonstrate proficiency in performing provider education and
introductory meetings and presentations, including PacificSource
mission and business, InTouch functionality and registration,
claims procedures, administrative procedures, member plan
information, provider networks, and how to access appropriate forms
and information on the PacificSource website as well as contacting
appropriate PacificSource representatives for assistance.
* Prepare materials and presentations for the meetings. Ensure
providers are well informed around new policies, changes, and
* Provide education both in person and on the phone about InTouch
functionality and troubleshooting.
* Prepare and maintain provider service files.
* Assist in the maintenance of provider demographics and serve as a
resource to internal personal and provider office staff regarding
participating provider maintenance.
* Perform operational tasks related to participating provider
set-up and take necessary action to assure accurate internal
* Participate in the publication and mailing of the quarterly
provider newsletters by gathering information and writing
* Speak as a PacificSource representative at provider-related
* Attend provider-related conferences as a vendor in order to
distribute information, network, and answer questions about
* Place supply orders and update inventory of PacificSource logo
* Anticipate in local medical organizations such as Medical
Assistants Organization and local chapters of the American Academy
of Professional Coders (AAPC). Develop positive working
relationships with provider groups and their staff to assure that
providers' concerns are addressed by the appropriate person(s) in a
timely, responsive manner.
* Provide prompt, professional, and courteous service to providers,
members, and PacificSource employees.
* Engage in intradepartmental projects and be able to participate
knowledgeably and collaboratively to ensure success for department
* If necessary, act as the sole departmental representative on
cross-departmental initiatives, with broad, effective knowledge of
all aspects of departmental functions.
* As needed and consistent with proficiency and experience,
participate in elements of training for employees who are new to
* Able to confidently interact with all levels of management at
PacificSource, on an as-needed basis.
* Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
* Perform other duties as assigned.
Work Experience: A minimum of 2 years of PacificSource experience
as a Provider Service Specialist or a combination of Provider
Service Specialist and another internal position or 3 years of
external experience in related healthcare field.
Education, Certificates, Licenses: High school diploma or
equivalent required. BS or BA in business or healthcare
administration preferred. A CPC or CPC-P certification is
* Excellent written and oral communication, including diplomacy
skills for working with the medical professional community as well
as the members enrolled in a PacificSource plan.
* Ability to effectively explain administrative and claims
procedures to provider office staff of varying educational
backgrounds and familiarity with insurance billing.
* Basic math skills required, including percentages, ratios,
graphing and spreadsheet skills.
* Ability to read, understand and communicate PacificSource policy.
Effective problem solving skills.
* Ability to read, understand, and communicate provider contractual
* Medical terminology proficiency.
* Experience or education in ICD-10-CM and coding.
* General computer, word processing and spreadsheet skills.
* General clerical skills.
* Ability to remain current on PacificSource administrative and
claims procedures, healthcare and the health insurance industry,
and claims coding issues.
* Excellent public relations skills.
* Ability to prioritize work.
* Current driver's license.
* Travel throughout the state, generally by automobile, with some
overnight visits required.
* Building Customer Loyalty
* Building Strategic Work Relationships
* Building Trust
* Continuous Improvement
* Contributing to Team Success
* Planning and Organizing
* Work Standards
Environment: Work inside in a general office setting with
ergonomically configured equipment. Travel is required
approximately 30% of the time or as needed to complete minimum
requirements for site visits, workshops, and provider
We live and breathe our values. In fact, our culture is driven by
these seven core values which guide us in how we do business:
* We are committed to doing the right thing.
* We are one team working toward a common goal.
* We are each responsible for customer service.
* We practice open communication at all levels of the company to
foster individual, team and company growth.
* We actively participate in efforts to improve our many
communities-internally and externally.
* We actively work to advance social justice, equity, diversity and
inclusion in our workplace, the healthcare system and
* We encourage creativity, innovation, and the pursuit of
Physical Requirements: Stoop and bend. Sit and/or stand for
extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively.
Disclaimer: This job description indicates the general nature and
level of work performed by employees within this position and is
subject to change. It is not designed to contain or be interpreted
as a comprehensive list of all duties, responsibilities, and
qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Keywords: PacificSource, Portland , Provider Services Representative, Other , Portland, Oregon
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