Volunteers of America National Services- PACE is seeking a Provider Relations Representative to service our North Carolina location: 5400 S. Miami Blvd suite 150, Durham NC, 27703.
Schedule: M-F 8:00 AM-5:00 PM Service Area locations and in the field sales
Benefit Highlights:
403(b) Retirement Plan
Career scholarships;
Continuing career education and leadership programs;
Dental and Vision Insurance
Paid Time Off (Vacation, Holiday & Sick Days)
About the Job:
Maintain the provider network for assigned VOANS PACE Organization(s).
Essentials:
Develops and maintains strong relationships with healthcare and other service providers, including physicians, hospitals, clinics, and ancillary service providers.
Initiates and maintains effective communication channels between contracted providers and PACE clinical and administrative teams to develop cohesive, high performing working relationships.
Serves as the primary point of contact for provider inquiries, concerns, and escalations, ensuring timely resolution and follow-up.
Collaborates with internal departments, including claims, contracting and credentialing, to resolve provider-related issues in a timely manner and ensure seamless service delivery.
Exhibits understanding and sets priorities to handle multiple tasks simultaneously, and designs work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion.
Completes orientations, training and development for new and existing network providers.
Gathers, reviews, and verifies all pertinent information relating to participating network providers.
Communicates with the Provider Relations Manager on provider updates, issues and concerns and collaborates on projects.
Plans and facilitates meetings with current and prospective contracted providers.
Works with contracted providers to adhere to contract and regulatory requirements.
Monitors and prepares routine reports for the Provider Relations Manager on provider satisfaction and other provider metrics.
Conducts proactive provider outreach, networking and education initiatives to promote PACE.
Assists in the development of strategies for provider network expansion and growing enrollment referral streams.
Prints, packages, mails or distributes in person company flyers, post cards and, educational materials for existing and prospective network providers.
Travels within designated service area to provider offices and PACE Center as required in order to accomplish the position's tasks.
Stays informed about changes in healthcare regulations and company policies that may impact providers.
Other duties as assigned
Required Qualifications:
Bachelor's degree in Healthcare or Business Administration or closely related field.
Minimum two years in client services and provider relations.
Ability to communicate and work effectively with various levels of facility and VOA/VOANS staff and providers.
Analytical and organizational ability.
Self-motivated, disciplined, detailed and career oriented.
Integrity driven.
Knowledge of HIPAA law.
Knowledge of PACE regulations.
Knowledge of claims processes and data capturing.
At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations' shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best
