Description

ESSENTIAL FUNCTIONS/RESPONSIBILITIES

§  Assure assigned providers have current copies of all relevant educational material; be responsible for accurately and consistently interpreting materials for providers and identifying and proposing solutions to problems as they arise.

§  Develop and implement an action plan in response to each provider service call and work to ensure timely problem resolutions. 

§  Implement quality indicators for use within the network, including working with providers as necessary to assure full understanding and compliance, which may include regular provider service meetings.

§  Gain a thorough understanding of database functionality and/or provider portal platforms and be able to convey instruction in a group setting.

§  Understand and communicate details of operational processes and plan procedures, including the authorization process.

§  Share and educate providers on the Provider Manual (appropriate to the geographic operating area) and provider collateral training materials.

§  Act as a liaison between AHS and providers with claim issues.

§  Perform a variety of tasks that change daily.

§  Other duties as assigned.

QUALIFICATIONS AND EDUCATION REQUIREMENTS

§  A bachelor's degree in healthcare, human services, public speaking, or a related field is desirable.

§  2 years of experience in provider relations preferred.

§  Excellent written and oral communication skills.

§  Must clearly and consistently articulate complex information, including standards of care and specifics of the various provider agreements.

§  Experience as a provider relations professional in a managed care setting and/or knowledge of Medicare/Medicaid a plus.

§  Independent problem-solving skills, including the ability to address issues in a timely and accurate manner.

PREFERRED SKILLS

§  Comfortable with public speaking or speaking within a group setting.

§  Strong customer service skills, including the ability to employ stress de-escalation techniques.

§  Ability to follow instructions.

§  Ability to properly identify and differentiate documentation.

§  Proficiency in MS Office Suite.

ADDITIONAL NOTES

§  Must possess a valid driver's license.

§  Must be willing and able to handle day trips within the service area at least 75% of the time.

§  Equivalent or similar work experience will be considered in lieu of the above Qualifications and Education Requirements.

Summary

The Provider Relations Representative will develop working relationships with in-network providers, clinics, and hospitals.  They will manage assigned providers for whom they are the principal point of contact and assist with additional providers as needed. Under the supervision of the Director of Provider Communications, the Provider Relations Representative is expected to ensure that provider offices are fully educated on appropriate policies and procedures for conducting business with commercial and Medicare Advantage client health plans.  They will present comprehensive knowledge of the authorizations and claims functions, credentialing requirements, the application and contracting process, and other topics of general and specific interest to the provider.