Alivi is Hiring a Provider Relations Representative Palm Beach FL Near Beach, FL
Must reside in the Palm Beach area or surrounding area SUMMARYThe Provider Relations Representative serves as the primary liaison between Alivi and our network of NEMT Providers. The Provider Relations Representative will provide training, education and guidance while building a strong relationship with our provider partners by in-person or virtual visits, and phone calls. The Provider Relations Representative is responsible for ensuring network adequacy by identifying, attracting, negotiating, and contracting quality specialty providers. DUTIES & RESPONSIBILITIESProvider Network Management
Functions as the single point-of-contact for all issues related to the network
Performs root cause analysis and resolution on provider related complaints, claims reported to have been processed incorrectly, claim rejections, payment issues, etc
Facilitates provider education and training to increase their familiarity and satisfaction with systems, policies, and procedures
Ensures provider adherence to the Provider Manual
Manages providers in multiple markets, regions, counties
Visits providers in person for relationship building and for training and education purposes
Preforms in person site inspections as needed
Assists in compiling, communicating, and mailing general materials to network providers as required
Manages multiple tasks, detail-oriented, responsive, and critical thinking
Establish and complete monthly touchpoints and conduct quarterly business reviews with network providers
Network Adequacy
Conducts research and contacts qualified providers by phone, email, or in-person to target adequacy gaps and hot spots.
Effectively recruits, negotiates, and contracts providers from multiple lines of business.
Maintains provider network adequacy in assigned region(s)
Gathers all provider/facility credentials and submits a complete file to the credentialing department
Field Inspector
Perform detailed vehicle inspections to ensure compliance with safety standards and operational guidelines
Complete CTAA PASS certification to understand and adhere to safety protocols during inspections
Ensure familiarity with wheelchair vehicle components and proper member securement techniques
Gather information and observations related to unsafe circumstances, service complaints, provider behavior, or vehicle condition/performance
Investigate complaints or issues reported by members or facilities and Document and report findings to facilitate appropriate corrective action
Identify and evaluate additional providers in specific areas
Observe provider behavior on the road and at facilities, including loading and unloading procedures. Assess proper levels of service (LOS), member securement, safety practices, and On-Time performance (OTP) by provider
Serve as a resource for facilities by making regular visits and introducing yourself to facility staff
Address service issues or failures by coordinating with providers and facilities to implement resolutions
Foster and improve relationships between facilities and providers through effective communication and problem-solving
Other
Conveys a strong professional image, exhibits interest, and a positive disposition in all aspects of the role
Maintains an accurate provider database of leads and accounts for all networks.
Leverage SalesForce CRM tool to maintain all provider/vendor accounts, documents, notes, and communication
Be the Alivi Brand Ambassador for network providers
Travel to network provider offices/facilities
Other duties as assigned
& QUALIFICATIONS
High school diploma or equivalent.
Fluent in English, and Spanish would be a plus
2 years of related experience and/or training
Experience with Microsoft Word, Excel, PowerPoint, and Outlook.
Self-starter, able to work independently and handle ambiguity.
Strategic, analytical, process-oriented with critical thinking skills.
Excellent written and verbal communication skills
Strong Customer Service orientation
Ability to work independently or in a team environment
Excellent problem-solving skills, good follow-up abilities, and willingness to be flexible and adaptable to changing priorities
Experience in customer service, claims processing, claims auditing or provider relations for Provider Networks in Podiatry and/or Chiropractic is desirable
Proficiency in creating and analyzing Network Adequacy reports is desirable. Experience presenting to a variety of audiences is desirable
Experience with Medicare Advantage, Managed Medicaid, and Commercial health plans is desirable
CTAA PASS certification (or willingness to obtain upon hire)
Strong understanding of vehicle safety and inspection protocols
Ability to work independently and collaboratively in the field
Excellent observational and investigative skills
Remote position with travel as needed within Palm Beach and surrounding countiesPowered by JazzHR 6UuSlsepgQ