Provider Relations Specialist - Tamuning, , Guam
19 hours ago
Job description
Job Summary:
Reports directly to the Provider Relationship & Network Contracting Manager and serves as the primary contact and liaison between TakeCare and contracted healthcare providers.
Essential Duties and Responsibilities:
- Build and maintain positive and strong working relationships with physicians, hospitals, clinics and ancillary providers.
- Serve as the main point of contact for provider inquiries regarding contracts, claims, credentialing and policies.
- Educate providers on health plan procedures, reimbursement guidelines and network requirements
- Coordinates provider onboarding, orientation and training
- Support network development initiatives including recruitment, retention of providers and benchmarking.
- Resolve provider issues and escalate complex concerns when necessary
- Conduct provider site visits and performance review as required
- Monitor provider compliance with contract terms and regulatory standards.
- Collaborate with internal departments to include claims, credentialing, quality improvement and compliance.
- Maintain accurate provider records and documentation.
- Performance other duties that may be assigned from time to time.
Education and Experience:
- Bachelor's Degree or minimum of 5 years experience in managing relationship and communicating with vendor/client partners
- Ability to work independently and manage multiple priorities.
- Excellent problem solving and conflict resolution abilities.
- Effective team player. With very good interpersonal relationship skills and can work and relate well with co-employees, patients and customers.
- Must have behavioral sensitivity, maturity, diplomacy and tact in complex situations and handling irate customers.
- Outstanding oral and written communication skills.
- Strong ethics and a high level of personal and professional integrity.
- Computer literate and very highly proficient in using MS office programs
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