Responsible for providing quality, accessible and comprehensive service to the company's provider community.
How You Will Make an Impact:
Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues
Collaborates with internal matrix partners to triage issues and submit work requests
Generally assigned to a portfolio of providers within a defined cohort
Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners
Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs
Coordinates and conducts provider training including developing and distributing provider relations materials
May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues
May coordinate Provider Manual updates/maintenance
Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
Research issues that may impact future provider contract negotiations or jeopardize network retention
Required Qualifications:
Requires a bachelor's degree; a minimum of 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
Excellent problem solving and analytical skills is a must
Experience with Medicare, Medicaid, and or commercial experience preferred
