Provider Experience Representative - Springfield, United States - Health New England

Description

Job Description

Job Description

Purpose

The Provider Experience Representative Contributes to the overall success of the Provider Excellence ensuring specific individual goals, plans, and initiatives are executed / delivered in support of the team's business strategies and objectives. Ensures all activities conducted are in compliance with governing regulations, internal policies and procedures.

Accountabilities

• Champions a customer focused culture to deepen client relationships and leverage broader Health New England's relationships, systems and knowledge.
• Understand how Health New England's culture and the CX Promise should be considered in day-to-day activities and decisions.
• Actively pursues effective and efficient operations of their respective areas in accordance with Health New England's Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.
• Champions a high performance environment and contributes to an inclusive work environment.
• Develops and maintains positive working relationships with key contacts at selected Provider organizations, such as hospitals, large regional practitioners groups, and other providers as identified and assigned for the purpose of resolving provider issues, addressing concerns/inquiries, evaluating requests, and identifying training and education opportunities.
• Adheres to established processes and procedures for addressing or reassigning provider inquiries, requests, or grievances and aids in: determining root causes, developing standard and non-standard resolution options, relaying expected timelines for resolution, and executes provider communication protocols.
• Participates, as requested, in functional workgroups such as Provider Joint Operating Committees (JOC), provider renegotiation meetings, and regulatory and accreditation meetings
• Assists in the development of, and regularly reviews, the Provider Support team on-line resources and training aids to ensure timely and accurate information - recommends updates as necessary.
• Serves as a resource for the Provider Support team with regards to clarifying Departmental processes and procedures, escalated provider issues, exception requests, and grievances.
• Assists in broad issue identification and resolution by reviewing team reports to identify trends and collaborate with the appropriate HNE functional areas for viable short and long term solutions to avoid reoccurrences and increase provider satisfaction.

Position: : Provider Experience Representative /Provider Experience Reporting Relationships (Job Titles only)Primary Manager:

(include secondary Manager if applicable)

• Manager of Provider Experience

Direct Reports:

• None

Shared Reports (solid/dotted if applicable):

• None

External/Internal Contacts

Internal

• Provider Contracting
• Provider Operations
• Legal
• Claims & Claims Operations (Configuration)
• Healthcare Services

External

• Hospitals and individual/group practices
• Department of Insurance
• Department of Health
• Healthcare Trade Organizations

Education / Experience / Other Information (include only those that are specific to the role)

Bachelor's degree or an equivalent combination of education and experience in business or a related field with a minimum of three years health care/provider servicing experience

• Demonstrated achievement and progressive responsibilities in the area of provider servicing and issue resolution
• Knowledge of managed care financing, provider reimbursement, and claims payment mechanisms
• Working understanding of NCQA and HEDIS and government regulations
• Broad based knowledge of Medicare, Medicaid, and commercial product offerings
• Proficiency with Microsoft applications