Position Summary
The Provider Relations Representative is responsible for servicing Providers through public relations, problem solving, education, communication and support of the policies and procedures. This role will provide education, training, and support for all providers.
Essential Responsibilities
Responsible for establishing and maintaining relationships with providers and their office managers by planning scheduled office visits.
Provides detailed on boarding to new physicians who join the network.
First line of contact for all interdepartmental requests related to provider relations issues.
Assist with activities and functions as they relate to physician growth as well as identifying network trends and gaps by working with internal departments and analyzing reports.
Primary coordinator access/trainer of portal implementation and responsible for increasing portal enrollment.
Assist in contracting with obtaining copies of contracts related to network management.
Serve as in-house PR rep weekly, staffing provider relations line and assisting other departments in resolving provider issues.
Coordinates with customer service department to resolve provider issues.
First line of contact for all interdepartmental requests related to Provider Relations issues.
Reports any dissatisfaction among providers and resolves within limits of authority, reporting issue and resolution to the Director of Client Services.
Educate provider network in identified areas of improvement such as urgent vs. non-urgent referrals, etc.
Assists with provider events, Power Point presentations, hand-outs, packets and agendas as assigned. Staff primary care physician form, mixers and other physician events.
Promote electronic submission capabilities including the timely and complete submission of encounter data, claims and utilization data.
Review and verify Provider Directory information and lead investigation and resolution of reported Provider Directory inaccuracies.
Works with Credentialing to ensure initial primary source verification and ongoing provider compliance while actively contracted.
Assist with the development of the Provider Policy and Procedure Manual as we do not currently have one.
Assist with the development of written communication to the Provider network as requested.
Maintain accurate and timely log of Provider visits in compliance with NCQA standards, and DHCS and CMS regulatory requirements.
Conduct Provider orientations, continuous training and education to Providers and office staff.
Assists with projects as needed and required (i.e., Data Validation, Provider Satisfaction Surveys, etc.).
Qualifications
High School Diploma or equivalent experience.
Minimum of five years’ experience working in healthcare with 3-5 years
Strong verbal and written communication skills
Possess strong business acumen and professionalism.
Demonstrated ability to serve in a customer (provider) facing role and collaborative and relationship-driven style in building effective data transmissions between entities.
Must be proficient in Microsoft Office, Excel and word.
Knowledge of HIPAA transaction sets, regulations/privacy laws.