- Work with client to insure adequate physician network retention, expansion and recruitment.
- Responsible for provider education regarding services, policies, and procedures.
- Responsible for handling daily provider inquiries, including capitation and reimbursement issues.
- Assist in physician communication programs and strategy.
- Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO).
- Communicate with payors and network providers, both orally and written, in association with operational and contractual related issues.
- Serve as client liaison and advocate with all departments.
- Assist in client related projects.
- Assist in identifying issues, problems, and areas where performance could be improved.
- Represent at physicians offices, contracted health plans, and committees when necessary.
- May attend client meetings where necessary to facilitate communication of information.
- Develop and present educational pieces at network provider meetings.
- Assist in periodic statistical performance reporting to clients.
- Assist Network Management and Member Services Manager with the development of strategic plans for servicing network physicians.
- Develop, recommend, and implement new policies and procedures.
- Play a key supportive role in Quality Initiatives.
- Perform other job as assigned.
- Knowledge of managed care market, strategies, and physician compensation models.
- Knowledge of medical group/IPA operations.
- Verbal and written communication skills.
- Public speaking and interpersonal skills.
- Ability to present oneself professionally and have the ability to address large groups of people in educational forums.
- Research and analytical skills.
- Ability to research complex contractual documents for interpretive purpose and utilize critical thinking skills.
- Skilled in Word, Excel, Power Point, and Visio.
- Ability to prioritize.
- Ability to analyze complex situations and accurately identify key components.
- Ability to multi-tasks simultaneously.
- Ability to travel locally.
- Knowledge of claims payment systems.
- Excellent problem-solving skills and is able to identify and adapt to shifting priorities.
- Bachelors degree in business, health care or related field, OR equivalent experience required
- 3 years of experience with quality assurance, provider relations, network management, or similar in a healthcare setting.
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Provider Relations Specialist - Campbell, United States - Insight Global
Description
Title
Network Management Associate (Provider Relations Specialist)Duration
4 Month Contract to HireLocation
Campbell, CASchedule
Monday to Friday, 8am-5pm PSTPay
$80K-$97K, based on experienceDUTIES INCLUDE BUT NOT LIMITED TO:
KNOWLEDGE, SKILLS AND ABILITIES
Must Have:
