Provider Service Agent - JHP

Job Details

The Provider Services Agent plays a critical role in supporting Jefferson Health Plans' provider network by serving as a trusted resource and fostering positive provider relationships. This call center-based position acts as a liaison between providers and the organization, helping to ensure providers receive timely assistance, accurate information, and exceptional service experience. This role requires strong communication, problem-solving, and customer service skills, as well as the ability to navigate multiple systems and adapt to a fast-paced environment. Through effective issue resolution and provider support, the Provider Services Agent contributes to operational excellence, provider satisfaction, and the overall success of Jefferson Health Plans.

Job Description

Summary
The Provider Services Agent plays a critical role in supporting Jefferson Health Plans' provider network by serving as a trusted resource and fostering positive provider relationships. This call center-based position acts as a liaison between providers and the organization, helping to ensure providers receive timely assistance, accurate information, and exceptional service experience. This role requires strong communication, problem-solving, and customer service skills, as well as the ability to navigate multiple systems and adapt to a fast-paced environment. Through effective issue resolution and provider support, the Provider Services Agent contributes to operational excellence, provider satisfaction, and the overall success of Jefferson Health Plans.

Job Duties

• Serve as a primary point of contact for providers, delivering accurate, professional, and timely support regarding eligibility, benefits, authorizations, claims status, network participation, and plan policies.
• Investigate and resolve provider inquiries by reviewing claims, researching issues, coordinating with internal departments, and facilitating appropriate escalations to ensure effective resolution
• Educate providers on Jefferson Health Plans processes, programs, and self-service tools, including Provider Portal capabilities and available resources
• Accurately document provider interactions and maintain compliance with departmental procedures, quality standards, and documentation requirements
• Efficiently manage inbound and outbound communications while adhering to established protocols for information security, call handling, and cross-functional collaboration
• Meet established performance, productivity, and quality standards while participating in ongoing training and professional development activities
• Contribute to a positive provider experience by supporting operational initiatives, maintaining current knowledge of plan guidelines, and performing other related duties as assigned

Minimum Qualifications

• High School Diploma/GED or 3 years of equivalent work experience.
• 2 years of inbound call center experience.
• Strong organizational, analytical, communication, and interpersonal skills with the ability to effectively manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office applications and the ability to efficiently navigate multiple systems, databases, and applications while maintaining a high level of accuracy and attention to detail.
• Demonstrated problem-solving and customer service skills, including the ability to quickly identify issues, provide effective solutions, and de-escalate challenging situations
• Dependable, adaptable, and goal-oriented professional with the ability to work independently and collaboratively while maintaining productivity in high-pressure environments.

Preferred Qualifications

• Claims experience preferred, including knowledge of HCPCS, ICD-10 coding, and government-sponsored healthcare programs such as Medicaid, CHIP, and Medicare.
• Experience using healthcare and customer relationship management systems (e.g., HRP, EPIC, Salesforce, HealthTrio, eCIS, CRM platforms) with the ability to work effectively both independently and within a team environment

Additional Qualifications

Physical Demands
Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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