Responsible for providing quality, accessible and comprehensive service to the company's provider community. Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
How You Will Make an Impact:
Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners
Collaborates within a cohort of internal matrix partners to triage issues and submit work requests
Generally, is assigned to a portfolio of providers within a defined cohort
Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes
May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues
Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs
Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA)
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; minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
Provider relations experience strongly preferred
Provider contract language preferred
Ohio Medicaid experience strongly preferred
Public speaking experience preferred
Medicaid professional and facility Claims/billing knowledge preferred
