Peak TPA isa third party administrator (TPA) that provides back-office functions for capitated health plans. Back-office functions include but are not limited to claims adjudication, member enrollment and reporting, and financial reporting. Peak TPA's partner company, Mediture/Cognify, has a long history in providing software solutions for managing care coordination for capitated health plans. Both companies (subsidiaries of Tabula Rasa Healthcare Company) work closely together to provide integrated and intuitive products to our health plans.
Peak TPA's goal is to seamlessly handle our client’s back-office functions to allow the plan to financially thrive and grow so they can focus on member care coordination.
PROVIDER SERVICE REPRESENTATIVE
Under supervision of the Client Service Manager, the Provider Service Representative is responsible for answering calls from our clients’ medical provider network and providing timely and accurate responses in a professional and courteous manner. Calls are usually regarding claim status, and from time to time outbound calls may be required. This position also assists with various internal tasks that ensure a high level of overall client satisfaction.
- Answer inbound calls in adherence to standard policies and procedures, ensuring calls are accurately resolved
- Responsible for inquiry inbox and voicemail
- Responds to inquiries in a timely manner
- Researches inquiries using appropriate team members as a resource
- Follows up with providers as needed to relay claim status or obtain further information
- Assists team with providing claim status for client inquiries
- Ensures that HIPAA guidelines are following in every communication with providers, clients or staff
- Assists with special projects, as requested
- Communicate clearly and concisely,with sensitivity to the needs of others
- Maintains the confidentiality of all company procedures, results, and information about participants, clients,providers and employees
- Maintain courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups (internally and externally); consistently cooperates and supports organization in problem solving issues; ensures customer satisfaction by understanding and applying best practices, procedures and standards of the organization; support the success of the entire team
- Follows all Policies and Procedures and HIPAA regulations
- Maintains a safe working environment
- Establishes and maintains effective working relationships with co-workers
- Participates in any recommended or required training sessions
- High School Diploma or equivalent. Minimum of one year of professional work experience required, preferably in a health plan setting
- General knowledge of medical terminology preferred
- Requires strong knowledge of current computer technology, including the use of computers; Intermediate level of knowledge and proficiency with associated software, including Word, Excel and Outlook. Experience with mail merge is preferred. Working knowledge of health insurance is helpful.
- Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
- Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
- Ability to have superior attendance to fulfill all position functions
- Detail oriented with strong analytical, multi-tasking and organizational skills
- Ability to prioritize effectively
- Ability to work independently with minimal supervision
- Ability to communicate professionally, clearly and effectively, verbally and in writing
- Ability to remain calm under stress
Supervisory Responsibility: None.
Expected Hours of Work: This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.
Normal business hours are typically between 8:00 a.m. to 5:00 p.m.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- Required to talk and hear by way of the telephone with participants, customers, vendors and staff; majority of the work day is spent communicating on the telephone
- Operates a computer and other office machinery such as copy machine, fax machine, office printer.
- Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy.
- Remains stationary for extended periods of time
- Occasionally exerts up to 20 pounds of force to lift, carry, push,pull or move objects
- Occasional reaching to retrieve shelved items or bending to access file cabinets
Environment: This job operates in a professional,dress for your day, office environment with a conversational noise level. No substantial exposure to adverse environmental conditions is expected. Moderate pressure to meet scheduled appointments and deadlines. Moderate potential for occasional verbal aggression by providers and clients.