Kpg Provider Services Jobs in Usa

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPAL RESPONSIBILITIES:

Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and tasks are submitted. Identify the caller's needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the plan, the provider network, and other community agencies. The MSR positions are flexibly staffed classification and work is expected to be performed minimally at the MRS II level. However, the initial selection will be made at the entry level MSR I. Our more advanced level position of the series is the MSR III who will be required to perform a variety of complex matters.

Member Services Representatives are under the direction of a Member Services Supervisor, Manager and Director, and service our members through our call center as well assisting other departments with responses to member issues by initiating communication between departments to ensure action, cooperation, and compliance of managed care operations.

Member Services Representative I

This position which requires the ability to work as a team player within the Alliance and with external contacts, make sound judgments based on analysis of information, be an effective communicator, active listener and balance advocacy for the member with the policy provisions such as plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations. The MSR provides courteous, professional, and accurate responses to incoming inquiries regarding network, plan benefits, eligibility, authorizations, plan services and guidelines, as well make decisions with the goal of ensuring member satisfaction and retention. The MSR performs a variety of complex functions and is also responsible for maintaining accurate and complete inquiry/grievance records in the electronic database. Maintains compliance with DMHC regulatory requirements and DHCS contractual obligations. MSR I staff who demonstrate proficiency in meeting, maintaining and exceeding principal performance objectives and metrics may be eligible to be promoted to a Member Services II or III role. Member Services Representative I staff may be eligible for promotion to Member Services Representative II or III positions once they have worked as a MSR I for a minimum of 12 months to be proficient with program and system knowledge in addition to meeting performance matrix requirements.

Principle duties and responsibilities

* Serve as the primary contact for members, providers and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions related to Alameda Alliance and provide accurate, satisfactory answers to their inquiries or concerns.

* Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination.

* Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in person.

* Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately.

* De-escalate situations involving dissatisfied customers, offering patient assistance and support.

* Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.

* Help guide and educate members about the fundamentals and benefits of managed health care topics, to include managing their health and well-being by selecting the best benefit plan service options, maximizing the value of their health plan benefits, and choosing a quality care provider.

* Intercede with care providers (doctor's offices) on behalf of the member, assisting with appointment scheduling; connect members with internal Case Management Department for assistance as needed.

* Assist members in navigating , the Member Portal, and other health care partner online resources and websites to encourage/reassure them to use self- service tools that are available.

* Manage any issues through to resolution on behalf of the member, either on a single call or through comprehensive and timely follow-up.

* Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.

* Provide education and status on previously submitted pre-authorizations or pre- determination requests for both medical and pharmaceutical benefits.

* Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.

* Always maintain a professional level of service to members.

* Always maintain confidentiality of information.

* Consistently support the Alliance's approach to Service Excellence by adhering to established department and company standards for all work-related functions.

* Interact positively with all Alliance Departments.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Process MS Dept projects

* Serve as a back-up to manage the escalated calls.

* Perform other duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

* Contacts: Receive, manage, and document telephone calls, emails, and other sources of contacts from members, potential members, and providers, and explain health plan benefits and plan rules. Describe the types of services the Alliance offers to the Member within the managed care system. Provide clarification about issues regarding patient and physician rights and how the plan operates.

* Conflict resolution: Resolve member problems/conflicts by convening with other departmental staff as needed.

* Member communications: Create and/or mail appropriate member materials and communications as needed.

* Computer: Perform ongoing data entry which assists in the maintenance of the Member Services department database to ensure data integrity.

* Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

* Constant and close visual work at desk or computer.

* Constant sitting and working at desk.

* Constant data entry using keyboard and/or mouse.

* Constant use of multi-monitor setup

* Frequent use of telephone and headset.

* Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

* Frequent lifting of folders, files, binders, and other objects weighing between 0 and 30 lbs.

* Frequent walking and Standing

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

* Bachelor's degree or equivalent experience preferred.

* High school diploma, GED required.

* The ability to speak and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English, Tagalog/English are required as designated.

* A bilingual proficiency exam will be administered to ensure the candidate possesses the appropriate skill level to meet requirements. The successful candidate must score 90% or higher.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

* Minimum one year of direct customer service experience. Call center experience and managed care experience a plus

* Experience determining eligibility for financial assistance, insurance benefits, unemployment and/or other social services programs.

* Demonstrated knowledge expert of AAH Member Services policies and procedures

* Consistent record of meeting, maintaining, or exceeding monthly Departmental performance metrics.

* Consistent track record of documenting Service Requests accurately and clearly and monitoring open Service Requests to ensure responses and closure.

* Consistent record of high quality of work as demonstrated through call and documentation auditing, appropriate Call Disposition coding, as well as an overall acceptable monthly Member Satisfaction Survey result as assessed by Member Services Quality Specialist, MS Trainer and Member Services Supervisor.

* Demonstrated proficiency in current Customer Relationship Management (CRM) tool, phone system software Quality Management Solution, Pharmacy Benefits Management applications (PBM), Interpreter vendor scheduling software, delegate portal solutions and the Alliance's Member portal.

* Demonstrated ability to effectively handle the department's key special projects: Member Portal Request Processing, Kaiser PTE Requests, PCP retroactive and same month requests.

* Demonstrated ability to help members face-to-face in the field and/or at the Alliance offices (walk-ins). Also highly skilled at handling issues related to member bills, transportation set-up and benefit coordination with providers and pharmacy needs.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

* Ability to prioritize and adapt to changing situations in a calm and professional manner.

* Ability to maintain composure in stressful situations.

* Excellent problem-solving skills

* Ability to exhibit cooperation, flexibility, and provide assistance when talking to members, providers, and staff.

* Skill in basic data entry

* Ability to type 40 net words per minute: multi-task

* Manual dexterity to operate telephone, computer keyboard equipment.

* Speak English proficiently, clearly, and audibly.

* Memorize and retain information quickly; meet physical requirements

* Spell correctly

* Learn the policies, regulations, and rules applicable to business operations.

* Follow instructions, reason clearly, analyze solutions accurately, act quickly and effectively in emergency situations; operate office equipment including computers and supporting word processing, spreadsheet, and database applications.

* Excellent phone etiquette and ability to communicate clearly and concisely, both orally and in writing.

* Excellent interpersonal skills with the ability to interact with diverse individuals and flexibility to customize approach to meet all types of member communication styles and personalities.

* Strong verbal and written communication skills.

* Demonstrated ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner, consistently meeting commitments).

* Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member.

* Must be self-motivated and able to work with minimal supervision

* Must be team-oriented and focused on achieving organizational goals.

* Proficient problem-solving approach to quickly assess current state and formulate recommendations.

* Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions which members can understand and act upon.

* Proficient conflict management skills to include ability to resolve issues during stressful situations and demonstrating personal resilience.

* Ability to work regularly scheduled shifts within the Alliance's hours of operation including the training period, with scheduled lunches and breaks, flexibility to adjust daily schedules; and to work over-time and/or weekends as needed.

* Medical terminology knowledge preferred

* Ability to work within a broad systems perspective

* Experience in use of various computer systems software as well as Microsoft Windows, and Microsoft Suite, especially Outlook, Word, Excel.

* Must have reliable and stable internet connection for remote work (50-100 Mbps download speeds).

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $22.88-$34.33 HOURLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.

Location: Moraine, OH

Target Salary: $130,000  +(depending on experience) + comprehensive benefits

A mission-driven PACE organization in Columbus is seeking a Primary Care Provider - Nurse Practitioner to join its interdisciplinary team serving frail and elderly adults. This is a highly collaborative, patient-centered role focused on comprehensive primary care, care coordination, and improving outcomes for older adults in a community-based model.

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  Collaborative interdisciplinary team (IDT) model with strong clinical support

  
  
  
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  Focus on relationship-based primary care—not volume-driven medicine

  
  
  
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  Opportunity to make a meaningful impact on aging adults and reduce hospitalizations

  
  
  
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  Competitive compensation and strong benefits package

  
  
  

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  Deliver comprehensive primary care, including history, physical exams, and ongoing assessments

  
  
  
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  Develop individualized care plans and collaborate closely with the IDT and Medical Director

  
  
  
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  Manage medications, reconciliation, and interactions with pharmacist collaboration

  
  
  
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  Coordinate specialist referrals and follow up on consults, labs, and imaging

  
  
  
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  Monitor participant status during hospitalizations and transitions of care

  
  
  
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  Participate in daily IDT meetings and contribute clinical insights

  
  
  
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  Educate participants and caregivers on self-care, medications, and wellness

  
  
  
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  Provide on-call coverage as part of a shared rotation

  
  
  
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  Support quality improvement initiatives, staff training, and clinical policy development

  
  
  
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  Ensure accurate documentation, coding, and compliance with regulatory standards

  
  
  

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  Nurse Practitioner (NP) license

  
  
  
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  Active state license (Ohio) and DEA/CDS

  
  
  
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  BLS required

  
  
  
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  Minimum 2 years of direct patient care experience (geriatric or frail population preferred)

  
  
  
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  Experience in managed care, primary care, or geriatrics strongly preferred

  
  
  

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  Valid driver’s license, reliable transportation, and required auto insurance

  
  
  
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  Medical clearance and immunizations

  
  
  
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  Background check, license verification, references, and drug screening

  
  
  

If you’re a clinician passionate about geriatric care and value team-based, patient-centered medicine, please apply for more details.

#AC1

#ACP

Summary:

Performs a variety of complex administrative duties for patients in need of routine and/or urgent appointments, medical procedures, tests, and associated ancillary services in an ambulatory in/outpatient setting. Assess patients’ needs, including but not limited to, financial counseling, interpreter services, social services and refers to appropriate person or area. Alerts providers to emergent patient care needs.

Responsibilities:

• Receives and directs phone calls from patients and physician offices
• Schedules patients for treatment by multiple providers and treatment areas, and arranges a variety of associated tests and procedures according to established guidelines and specific criteria
• Prioritizes appointments in a manner that fosters optimum patient care, efficient utilization of physician’s clinical staff, as well as equipment and facilities
• Handles urgent patient care calls and may alert providers to emergent patient care symptoms and concerns
• Schedules urgent care appointments as needed and directed by physician
• Greets patients for scheduled and/or urgent care appointments and procedures
• Confirms and verifies patient demographic and insurance information
• Collect co-payments from patients upon arrival when applicable
• Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information
• Collaborates with insurers to obtain patients’ prior-authorizations for procedures and tests as needed
• Follows guidelines established by insurers to ensure that pre-authorization, pre-certification, and physician referrals for treatment are obtained prior to patient visits.
• Verifies eligibility for procedures or tests from various health care institutions
• Reviews and audits billing discrepancy reports and researches errors for resolution
• Maintains accurate and timely records, logs, charges, files, and other related information as required
• Performs a variety of related administrative and clerical duties, such as retrieving files and other records, faxing, collating, data entry, and relaying messages to physicians, residents and staff
• Prepares special reports or spreadsheets for physicians as requested
• Complies with established departmental policies, procedures and objectives
• Complies with all health and safety regulations and requirements
• Contributes in maintaining a respectful environment of professionalism, tolerance, and acceptance toward all employees, patients and visitors
• Performs other duties as required.

Requirements:

• High School Diploma or GED required
• Proficient in software and computer systems
• Knowledgeable of business office terminology / procedures
• Ability to multi task and work under stressful situation
• Effective written and verbal communication skills
• 1+ year of customer service experience required
• Experience with medical office terminology preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Summary:

Performs a variety of complex administrative duties for patients in need of routine and/or urgent appointments, medical procedures, tests, and associated ancillary services in an ambulatory in/outpatient setting. Assess patients’ needs, including but not limited to, financial counseling, interpreter services, social services and refers to appropriate person or area. Alerts providers to emergent patient care needs.

Responsibilities:

• Receives and directs phone calls from patients and physician offices
• Schedules patients for treatment by multiple providers and treatment areas, and arranges a variety of associated tests and procedures according to established guidelines and specific criteria
• Prioritizes appointments in a manner that fosters optimum patient care, efficient utilization of physician’s clinical staff, as well as equipment and facilities
• Handles urgent patient care calls and may alert providers to emergent patient care symptoms and concerns
• Schedules urgent care appointments as needed and directed by physician
• Greets patients for scheduled and/or urgent care appointments and procedures
• Confirms and verifies patient demographic and insurance information
• Collect co-payments from patients upon arrival when applicable
• Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information
• Collaborates with insurers to obtain patients’ prior-authorizations for procedures and tests as needed
• Follows guidelines established by insurers to ensure that pre-authorization, pre-certification, and physician referrals for treatment are obtained prior to patient visits.
• Verifies eligibility for procedures or tests from various health care institutions
• Reviews and audits billing discrepancy reports and researches errors for resolution
• Maintains accurate and timely records, logs, charges, files, and other related information as required
• Performs a variety of related administrative and clerical duties, such as retrieving files and other records, faxing, collating, data entry, and relaying messages to physicians, residents and staff
• Prepares special reports or spreadsheets for physicians as requested
• Complies with established departmental policies, procedures and objectives
• Complies with all health and safety regulations and requirements
• Contributes in maintaining a respectful environment of professionalism, tolerance, and acceptance toward all employees, patients and visitors
• Performs other duties as required.

Requirements:

• High School Diploma or GED
• Proficient in software and computer systems
• Knowledgeable of business office terminology / procedures
• Ability to multi task and work under stressful situation
• Effective written and verbal communication skills
• 1+ year of customer service experience required
• Experience with medical office terminology preferred

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time

Job Summary

Under general supervision of Account Director, provides technical support and expertise to assigned customer. Conducts telephonic and electronic follow up and closing functions for open work orders on assigned accounts in order to meet the contractual obligations of the client. Intent is to ensure work orders are completed on time. This position will primarily involve handling customer communications on general trades-related work orders (with emphasis on plumbing, lighting, doors, and electrical repairs). Communications include but are not limited to keeping customers informed of work being performed at their location, providing updates to customers, and handling escalations. This position is the main point of contact for designated customers. Capabilities to understand and review quotes and provide recommendations for most effective, timely and cost conscious repairs.

Essential Duties & Responsibilities

• Perform administrative support to include work order management and scheduling, vendor management, purchase order coordination, reporting, and any other such task assigned by supervisors
• Provide technical direction and support to EMCOR Field Organization and subcontractors to ensure timely completion of all general trades-related work orders
• Respond to requests for maintenance and repair of facilities with an emphasis on plumbing, doors, and electrical situations affecting the facilities, etc.
• Maintain effective communications with employees, management, EFO/contractors, and customers as operations are 24/7.
• Assist customer and service providers with invoicing statuses and issues; escalate when appropriate
• Provide accurate reporting on open work orders for supervisor review as requested
• Document all work order related correspondence with customers and EFO/service providers to ensure files and work order history are always up to date and complete
• Will attend all required staff meetings and complete all required safety training

Qualifications

• Associates Degree or equivalent experience
• Minimum of 5 years of experience in general contractor trades maintenance and management or an equivalent combination of education and experience
• Bi-lingual English-Spanish preferred
• Advanced proficiency in MS Windows Applications, including MS Excel and Word. Must be able to Type min 50 wpm and have good writing skills
• Professional and friendly demeanor, willing to go above and beyond to accomplish the mission
• Ability to work under pressure and make correct decisions with limited input; know when to escalate issues to leadership
• Ability to communicate effectively and efficiently with all functions of the Operations Team and Call Center to carry out objectives of the program
• Ability to think critically and problem solve
• Ability to maintain a courteous, professional demeanor at all times
• Convey confidence in providing and receiving pertinent information
• Must be punctual, reliable and caring about their work ethic
• Capability to travel < 25% to customer headquarters or sites

Equal Opportunity Employer

As a leading provider of mechanical and electrical construction, facilities services, and energy infrastructure, we offer employees a competitive salary and benefits package and we are always looking for individuals with the talent and skills required to contribute to our continued growth and success. Equal Opportunity Employer/Veterans/Disabled

Notice to Prospective Employees

Notice to prospective employees: There have been fraudulent postings and emails regarding job openings. EMCOR Group and its companies list open positions here. Please check our available positions to confirm that a post or email is genuine.

EMCOR Group and its companies do not reach out to individuals to help with marketing or other similar services. If an individual is contacted for services outside of EMCOR’s normal application process – it is probably fraudulent.

Rheinmetall 4iG Digital Services (R4) is a joint venture between Rheinmetall, a globally leading supplier of defense and automotive products, and 4iG, Hungary's leading IT systems integrator. R4 has been founded end of 2022 with its headquarters in Budapest and the initial mission to provide project- and operations-related IT services to Rheinmetall's local subsidiaries in Hungary and worldwide. Based on business requirements and opportunities, R4 plans to progressively expand the scope of its services for internal and external customers alike. In a nutshell, R4 is like a start-up with guaranteed success. Equipped with a hands-on mentality, it significantly benefits from the support and tremendous growth of both Rheinmetall and 4iG. The designated business and solid setup offer outstanding development potentials for R4 itself but consequently also for all employees, because there will be lots of interesting jobs in an international and dynamic work environment.

In order to achieve our common goals, we count on you

* Design, implementation and operation of print management system and print servers.

* Takes over communication with the service provider and processes reported problems in close cooperation with the service provider

* Approves the system settings for the printing functions provided by the service provider and ensures that they are maintained

* Improves existing processes and technical solutions

* Is an active member of the team and contributes to continuous optimization with their experience

What you will need for successful work

* Degree in computer science, information technology, business information technology, or related field with relevant working experience

* Professional experience (min. 3 years) with print servers and printing solutions (follow me printing)

* Professional experience with printer hardware (especially Konica Minolta printers)

* Thorough knowledge of modern print management software

* Basic knowledge of networks, databases and application servers

* Recognising and communicating technical, structural and organisational problems and developing proactive solutions

* Close cooperation with other departments within the organisation

* Thorough work ethic with attention to detail

* Strong analytical skills combined with a strong service and customer focus

* Independent, proactive work

* Positive and solution-oriented mindset, team spirit

* Business fluent English and Hungarian, both written and spoken

What we offer

* Take over an important and challenging role with high visibility

* Become part of the unique growth stories of Rheinmetall and 4iG, which offer outstanding development and career opportunities

* Gain insight into the defense and automotive industry

* Make use of the broad network with over 30.000 great colleagues at Rheinmetall and 4iG worldwide

* Benefit from various professional trainings and events

* Enjoy our international and flexible work environment with an official office in Budapest but up to 100% mobile work

What we are happy about

* Experience with SafeQ, Siteaudit, and Autostore systems

* Knowledge of ITIL processes

* Experience with ServiceNow

* Software release management

* German language skills are an advantage