Provider Support Representative

Provider Support Representative - India (Remote)

Position Overview

As a Provider Support Representative at XO Health, you will be the first line of support for our provider network. You will manage inbound and outbound provider interactions via phone, email, and chat, ensuring providers have seamless access to the tools, information, and support they need to deliver optimal care. This role supports XO Health's mission by ensuring providers have a trusted point of contact to resolve inquiries related to eligibility, claims, prior authorizations, payment integrity, and clinical workflows.

This role requires a high degree of professionalism, operational rigor, and a service-first mindset. The ideal candidate will understand healthcare claims, medical management processes, provider network dynamics, and be proficient with technology-enabled service platforms like Availity and PayMedix.

Key Responsibilities

Provider Support and Relationship Management

• Serve as the primary contact for providers contacting XO Health's Virtual Contact Center.

• Answer inbound calls and respond to emails and chats from providers regarding:

• Member eligibility and benefits

• Claims status and adjudication details

• Prior authorization requirements and submissions

• Reimbursement policy questions

• Provider portal navigation (Availity, PayMedix)

• W-9 collection

• Educate providers on XO Health's unique operational models such as PayMedix payment consolidation and member no-pay policies.

• As needed, maintain accurate and timely provider data updates in XO Systems to support claims processing, reporting, directory publication, and data transfers.

Claims and Authorization Support

• Interpret and communicate Explanation of Benefits (EOBs), remittance advice, and other claims documentation.

• Assist with the intake and triage of claim disputes and appeals, guiding providers through resolution processes.

• Provide guidance on clean claim submission practices.

• Support providers with prior authorization requirements, using the XO Health Payer Space in Availity, including the use of Penguin AI for automation.

Documentation and Communication

• Maintain clear and accurate records of all interactions in CRM and call tracking tools.

• Follow SOPs for case documentation, escalations, and resolution tracking.

• Collaborate cross-functionally with Network Operations, Medical Management, and Claims teams to resolve complex provider issues.

Qualifications

Healthcare Industry Experience

• 2-4 years of experience in healthcare provider services, contact center operations, or payer operations.

• Strong working knowledge of US healthcare insurance operations, claims interpretation, case management and provider relations.

• Knowledge of healthcare regulations and compliance requirements (i.e. HIPAA, Medicare/Medicaid).

• High attention to detail and excellent written/verbal communication.

• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.

• Comfortable working in a remote, tech-enabled environment using platforms such as MS Office, Genesys, ServiceNow, or equivalent CRM tools.

Preferred

• Bachelor's degree in healthcare administration, business, or a related field preferred, high school diploma or GED Required.

• Experience working with PayMedix or equivalent consolidated billing/payment platforms.

• Familiarity with alternative payment models (e.g., bundled payments).

• Familiarity with provider tools including Availity Essentials, payer portals, and EDI standards.

• Bilingual (Spanish or other languages) is a plus.

Key Competencies

• Customer Focus: Commitment to providing responsive, empathetic service to providers.

• Problem Solving: Ability to analyze complex issues and recommend effective solutions.

• Technical Acumen: Comfort with health plan portals, CRM platforms, and claims systems.

• Communication: Ability to explain complex policies clearly and respectfully.

• Adaptability: Thrives in a fast-paced, evolving startup environment.

• Collaboration: Works cross-functionally with clinical, technical, and business teams.

Additional Details

• Availability: Must be able to support contact center hours and participate in a rotating on-call schedule for urgent provider support needs.

• • Location: Remote