Provider Support Representative

Summary

Join XO Health as a Provider Support Representative and be the primary point of contact for our provider network. Manage inbound and outbound communications via phone, email, and chat, ensuring seamless access to tools and information. Support providers with inquiries on eligibility, claims, prior authorizations, and payment integrity. Maintain accurate provider data and interpret claims documentation. Collaborate with internal teams to resolve complex issues. This role requires strong communication, problem-solving skills, and healthcare industry experience. The position is remote and offers a full compensation package based on experience and certifications.

Requirements

• 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

Responsibilities

• 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
• 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
• 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

Preferred Qualifications

• 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

Benefits

• Full compensation packages are based on candidate experience and relevant certifications
• ���1,000,000 — ₹1,500,000 INR