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Boerne

    Collections Specialist - Boerne, TX, United States - HealthTexas

    HealthTexas
    HealthTexas Boerne, TX, United States

    2 weeks ago

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    Description

    The Provider Relations Specialist for the continued development, implementation, compliance management of a cost-effective provider network, and support the day to day operational needs.

    This role will assist in the development of network-wide strategies to improve efficiencies and access.

    Under the direction of the Contract Manager, s/he performs all critical functions necessary to assess, develop, maintain, and/or improve provider network adequacy and performance.

    We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential.

    Our culture is the driving force behind our mission "to deliver quality and compassionate care with outstanding service, every patient, every time".

    As a Provider Relations Specialist at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.


    • Performs both internal and external outreach, monitoring, and resolution of operational and/or contractual provider related issues
    • Educates provider's staff and providers on policies and managed care/medical group expectations
    • Identifies network gaps and performs recruitment to address adequacy needs within the network
    • Will help execute, maintain, and review Value Based, Capitation, and FFS contracts
    • Be familiar with and have the ability to interpret policy and procedures to the relation of various healthcare contracts
    • Coordinates the management of internal HealthTexas systems to ensure the accuracy of the provider network.
    • Ability to manage and track projects and communicate the progress of the projects to senior leadership
    • Participate in audits and readiness assessments for contract compliance
    • Investigate and respond to complex provider related issues and initiate change of provider related database information
    • Serve as a subject matter expert for provider relations activities
    • Assists with In Network provider inquires and provider/group demographic changes within HealthTexas' claims and electronic medical record systems
    • 2+ years of experience with provider service/provider relations operations/managed care, or relevant experience preferred
    * claims processing, UM programs, provider contract administration, , HEDIS, CMS STARS, etc.

    • Effective communication (both verbal and written) and relationship building skills
    • Expertise in Microsoft Office programs and industry-standard applications as appropriate
    Preferred Bachelor's degree in Business Administration, Health Care Administration or other related field
    Strong organizational skills to manage multiple projects, issues, and priorities effectively and simultaneously, with attention to detail.

    • Expertise in Microsoft Office programs and industry-standard financial applications as appropriate
    Work Hours, Travel Requirements

    • Monday - Friday, 8:00 a.m. - and as needed to complete projects.
    • Travel to medical offices may be necessary for the purpose of providing benefit education.
    This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
    *
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