Provider Services Specialist

Location: Birmingham, AL

Work Schedule: Hybrid schedule with regular onsite work at the VIVA HEALTH corporate headquarters and some work-from-home opportunities.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan, receiving at least a 4 out of 5 Star rating for 10 years in a row, and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Provider Services Specialist will analyze and resolve all actionable Medicare grievances filed against contracted providers. This position will coordinate a timely resolution to the actionable grievances sent to Provider Services from the Medicare Appeals & Grievances department in accordance with the agreed upon terms of the Medicare Grievance Service Level Agreement. This role will be responsible for ensuring the completed actionable grievances responses are documented in the department's database systems. This position will also assist the Provider Services department with any other functions, projects, or tasks as needed.

Key Responsibilities

• Review actionable grievances upon receipt. Forward non-actionable grievances to the Medicare Member Appeals & Grievances department.
• Research actionable grievances prior to provider outreach.
• Outreach to providers for grievance resolution.
• Document grievance resolutions in applicable data systems.
• Maintain knowledge of departmental policies and procedures to meet compliance standards.

REQUIRED:

• High School Diploma or GED
• 1+ years' experience in a managed care company/health plan in customer service, claims, or appeals and grievances
• Demonstrate excellent customer service skills, both verbal and written
• Ability to work under pressure to meet deadlines with minimal supervision
• Proficiency with computer software including MS Word and MS Excel
• Demonstrate strong organizational and time management skills
• Ability to work independently and as a member of a team

PREFERRED:

• 1+ years' experience processing Medicare appeals and grievances
• Experience in the managed healthcare industry
• Advanced computer skills

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.