VillageCare
Provider Services Representative (Hybrid)
VillageCareMAX is seeking a motivated individual for a full‑time Provider Services Representative role. This position will act as the primary point of contact between VillageCareMAX and contracted/non‑contracted providers for MLTC and Medicare lines of business, submitting Organization Determination requests and related inquiries.
Responsibilities
Support the Utilization Management and Member Experience teams by managing incoming service requests.
Maintain call center KPI requirements and adhere to Quality Assurance guidelines.
Handle incoming provider requests via ACD calls and faxes, ensuring compliance with required timeframes; conduct outbound calls to provide first‑call resolution.
Initiate Organization Determination requests on behalf of providers.
Enter authorizations under guidance from the Interdisciplinary Care Team when needed.
Qualifications
Associate degree or bachelor’s degree in a related field.
Minimum 2 years of practical experience in a healthcare setting.
Excellent communication, organizational, and problem‑solving skills.
Must reside within the New York Tri‑State Area (NY, NJ, CT).
Benefits
Competitive salary: $25.01 – $28.14 per hour.
Paid Time Off package
10 paid holidays
Personal and sick leave
Medical, dental, vision plans
HRA/FSA
Education reimbursement
403(b) retirement savings
Life & disability insurance
Commuter benefits
Paid family leave
Additional employee discounts
Location 112 Charles Street, New York, NY 10014 – Hybrid (remote and office) requirements; must reside within the New York Tri‑State Area.
Equal Opportunity Employer VillageCare is an Equal Opportunity Employer.
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Responsibilities
Support the Utilization Management and Member Experience teams by managing incoming service requests.
Maintain call center KPI requirements and adhere to Quality Assurance guidelines.
Handle incoming provider requests via ACD calls and faxes, ensuring compliance with required timeframes; conduct outbound calls to provide first‑call resolution.
Initiate Organization Determination requests on behalf of providers.
Enter authorizations under guidance from the Interdisciplinary Care Team when needed.
Qualifications
Associate degree or bachelor’s degree in a related field.
Minimum 2 years of practical experience in a healthcare setting.
Excellent communication, organizational, and problem‑solving skills.
Must reside within the New York Tri‑State Area (NY, NJ, CT).
Benefits
Competitive salary: $25.01 – $28.14 per hour.
Paid Time Off package
10 paid holidays
Personal and sick leave
Medical, dental, vision plans
HRA/FSA
Education reimbursement
403(b) retirement savings
Life & disability insurance
Commuter benefits
Paid family leave
Additional employee discounts
Location 112 Charles Street, New York, NY 10014 – Hybrid (remote and office) requirements; must reside within the New York Tri‑State Area.
Equal Opportunity Employer VillageCare is an Equal Opportunity Employer.
#J-18808-Ljbffr