Provider Specialist - Spring Hill, United States - Access Healthcare Physicians, LLC

Access Healthcare Physicians, LLC

Verified Company

Spring Hill, United States

6 days ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Qualifications:

Current Active knowledge of daily operations of an MSO or IPA and current knowledge of coding that involves Medicare Risk Adjustments and HEDIS.

Valid Driver's License and Insurance Experience with Microsoft Word, Excel and Outlook

Experience working with physicians and their staff To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Responsibilities:

Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider issues.
Visit with assigned affiliate offices on a monthly basis to review Medicare related quality reporting; provide education; work with offices to resolve issues; and maintain close relationships with physician and office staff.
Prepare and analyze reports to assist physician in meeting financial, MRA, and quality (HEDIS, PQRS) goals. Demonstrate ability to review utilization reports including Part A, B, and RX claims, pmpm claims and service funds with physicians.
Perform Training and orientation including writing/updating orientation material when necessary and coaching for performance and improvement within physician practices.
Investigate and communicate provider / staff changes.
Educate providers regarding policies and procedures related to referrals authorizations and claims submission; web site education in regards to different insurance platforms, problem solving (liaison responsibilities)
Work on designated Projects as needed.

Education and/or Experience:
Associate's degree (A. A.) or equivalent from two-year college or technical school; or three months to one-year related experience and/or training; or equivalent combination of education and experience.

Preferred Qualifications:

5 years of experience in the Medicare risk field with experience in working with Primary Care physicians to meet financial, MRA and HEDIS goals.
Knowledge of HEDIS 5 Star and experience working reports.
High level customer service skills

Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions.

Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Travel Requirements:
The employee is constantly required to drive frequently in order to carry out their duties.

Pay:
$48, $55,000.00 per year

Benefits: