Provider Representative

Job description

·  Job Description:

DXC Technology (NYSE: DXC) is the world’s leading independent, end-to-end IT services company, helping clients harness the power of innovation to thrive on change. DXC Technology serves nearly 6,000 private and public sector clients across 70 countries. The company’s technology independence, global talent and extensive partner alliance combine to deliver powerful next-generation IT services and solutions. DXC Technology is recognized among the best corporate citizens globally. For more information, visit  www.dxc.technology .

The Insurance/Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Responds to provider appeals and meets with providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs

Responsibilities:

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Under minimal supervision performs routine to complex tasks that are related to various healthcare claims and policies. 

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Provide training to the provider community and work as a liaison with our customer to implement programs that are necessary for the Medicaid program. 

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Apply knowledge of established policies and procedures to resolve provider issues and work with our customer to ensure we are compliant.

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Exercise independent judgment within defined practices and procedures to determine appropriate action.

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Evaluates unique circumstances and makes recommendations.

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 Examples of work performed may include a visit to a provider’s office to install software and instruct the provider on how to use the software in compliance with the services they are providing. 

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Perform other duties as assigned and the business needs require. 

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Involved in training of peers and will take the lead in areas of expertise. Provide call center assistance as needed by the business.

Education and Experience Required:

·  Bachelor's degree or High School Diploma or equivalent work experience
·  Typically, 2-5 years of working experience.
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Healthcare or insurance experience a plus.

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HIPAA Compliant Transaction knowledge a plus

Knowledge and Skills:

·  Excellent oral and written communication skills
·  Demonstrates strong analytical skills and customer relations skills.
·  Self motivated with excellent time management and organizational skills, ability to work independently as well as part of a team
·  Ability to effectively prioritize and handle multiple tasks and work under aggressive time constraints
·  Excellent problem solving and decision making skills
·  PC Skills
·  Skilled with Microsoft Products(excel, word)