- Develop and maintain strong professional relationships with providers and their staff while functioning as a liaison to the provider community to research and resolve complex provider issues
- Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and other events
- Identify opportunities for provider training and education
- Orient providers on Neighborhood's policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and procedures;
- Take ownership of the provider relationship, ensuring all provider needs and concerns are addressed and resolved
- Work collaboratively departmentally and inter-departmentally to resolve provider issues to ensure an adequate and satisfied provider network
- Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
- Identify opportunities for improving the provider experience and participate in implementation of provider satisfaction initiatives.
- Work collaboratively departmentally and inter-departmentally to resolve provider issues to ensure an adequate and satisfied provider network
- Participate in departmental and interdepartmental meetings as appropriate and necessary
- Participate in the development of departmental policies, procedures and processes
- Maintain professional growth and development
- Represent organization at provider related events and other initiatives, as necessary
- Responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
- Other duties as assigned
- Bachelor's degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience
- Two (2)+ years' experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)
- Two (2)+ years' direct application of coding, billing and reimbursement mechanisms
- Two (2)+ years' experience with facility or professional provider relations
- Experience with commercial, Medicaid or Medicare reimbursement mechanisms
- Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
- Ability to interact well with individuals on all levels, and maintain a professional image and attitude
- Ability to manage data and processes in multiple platforms
- Ability to work cross-organizationally to achieve the goals of the company and department
- Ability to work independently
- Demonstrated knowledge of billing practices and reimbursement methodologies
- Detail oriented, with the ability to organize and ability to manage multiple projects simultaneously
- Excellent Customer Service Skills
- Excellent written and strong business communication skills (written and verbal) public relations, presentation and facilitation skills
- Strong analytical, problem solving and project management skills
- Understanding of provider and claim operations as they relate to health plans
- Understanding of provider's reimbursement methodologies and contract terms
- Must be able to travel within an assigned territory on a daily basis
- Understanding of claims operations
- Experience in Cognos
- Experience in MedInsight
- Experience in SharePoint
- Experience with commercial, Medicaid or Medicare reimbursement mechanisms
- Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)
- American Academy of Professional Coders (AAPC) certification
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Provider Relations Representative - Smithfield, United States - Neighborhood Health Plan of RI
Description
Job Details
Job Location Smithfield, RI - Smithfield, RI Position Type Full Time Education Level Bachelors Degree Travel Percentage Daily Job Shift Daytime Job Category Professional / ExperiencedDescription
This position is responsible for cultivating, maintaining and strengthening relationships with the provider community. In this highly visible field position, the provider relations representative acts as the primary liaison between the organization and its providers including primary care practices, specialists, physician organizations, hospitals, ancillary and long term services and supports providers. Primary responsibilities include establishing positive working relationships with providers, effectively communicating with and educating those providers about the organization and resolving provider inquiries.
Duties and Responsibilities:
Responsibilities include, but are not limited to:
Qualifications
Qualifications- Required:
Qualifications- Preferred:
