Provider Relations Representative

Responsibilities

• Act as the primary liaison between the Fund and provider network
• Perform virtual site visits to participating providers to offer continued education and training
• Coordinate and conduct provider recruitment activity, network analysis including contracts and network retention to ensure network adequacy
• Update participating providers regarding new policies and procedures. Review existing policy to ensure maximum compliance, troubleshoot issues raised by provider and distribute any needed material
• Identify non-compliant providers, and providers with member complaints; communicate provider specific problems to management and propose remedy
• Responsible for keeping abreast of departmental specific goals and reinforcing these goals to providers
• Maintain accurate records of contacts and reports
• Perform additional duties and projects assigned by management

Qualifications

• Bachelor’s degree in business or health related field
• Minimum two (2) years managed care, provider contracting or provider services experience required
• Basic skill level in Microsoft Word and Excel preferred
• Knowledge of healthcare terminology required; familiarity with contracting language and fee negotiations
• Ability to travel throughout assigned territories
• Excellent written and oral communication skills; effective customer service skills
• Excellent interpersonal skills; ability to maintain productive work relationships with various providers, departments, and professionals at all levels
• Good problem solver with excellent analytical skills
• Demonstrated organizational skills, record keeping, and time management skills
• Able to work well independently, handle multiple projects and assignments, and follow through to completion
• Must meet performance standards including attendance and punctuality