What are the responsibilities and job description for the Rep, Provider Relations I position at Ageatia Global Solutions?
Purpose
Performs a variety of administrative functions and coordination in support of the provider contracting process and initiatives. Responsible for responding to complex and escalated contracting inquiries from a variety of network providers and care partners related to Medicare, Medicaid, Commercial and DSNP contracts. Assists functional teams daily to ensure all requests are handled in a timely and customer focused, professional manner.
Essential Functions
35% Manage Contracting email boxes. Works with the appropriate leader to triage and respond to complex and escalated inquiries from external provider practices or health care entities, as well as internal requests and bring to resolution in a timely manner, or escalate to an accountable party. Follows up to ensure resolution and/or assists with tasks to support resolution.
30% Supporting and organizing contracting related workflows including but not limited to: Carrying out ad hoc mailings, uploading and printing of contracts, updating fee disclosures, editing/updating templates, gathering documentation for audits or other regulatory requirements, researching returned mail and triaging complaints/inquires.
15% Update and maintain supporting documentation, process and standard operating procedures for the department. Provides regular updates to management with regard to identified and outstanding issues or trends.
10% Maintain in-depth knowledge of Client's insurance plans, product offering and reimbursement models. Stays abreast of changes and trends in Health Care.
10% Other duties related to provider contracting and networks management as assigned.
Super Skills/Competencies
Organizational skills.
Effective writing skills.
Deadline driven.
Sense of urgency.
Proficiency with Microsoft Office 365 to include proficient and successful utilization of Word, Excel, Outlook and teams.
Great customer service and follow up skills.
Qualifications
Interest in understanding the healthcare industry, health environment, health insurance payer environment.
Understanding of Health benefits.
Preferred Qualifications
A High School Diploma or GED is required.
Performs a variety of administrative functions and coordination in support of the provider contracting process and initiatives. Responsible for responding to complex and escalated contracting inquiries from a variety of network providers and care partners related to Medicare, Medicaid, Commercial and DSNP contracts. Assists functional teams daily to ensure all requests are handled in a timely and customer focused, professional manner.
Essential Functions
35% Manage Contracting email boxes. Works with the appropriate leader to triage and respond to complex and escalated inquiries from external provider practices or health care entities, as well as internal requests and bring to resolution in a timely manner, or escalate to an accountable party. Follows up to ensure resolution and/or assists with tasks to support resolution.
30% Supporting and organizing contracting related workflows including but not limited to: Carrying out ad hoc mailings, uploading and printing of contracts, updating fee disclosures, editing/updating templates, gathering documentation for audits or other regulatory requirements, researching returned mail and triaging complaints/inquires.
15% Update and maintain supporting documentation, process and standard operating procedures for the department. Provides regular updates to management with regard to identified and outstanding issues or trends.
10% Maintain in-depth knowledge of Client's insurance plans, product offering and reimbursement models. Stays abreast of changes and trends in Health Care.
10% Other duties related to provider contracting and networks management as assigned.
Super Skills/Competencies
Organizational skills.
Effective writing skills.
Deadline driven.
Sense of urgency.
Proficiency with Microsoft Office 365 to include proficient and successful utilization of Word, Excel, Outlook and teams.
Great customer service and follow up skills.
Qualifications
Interest in understanding the healthcare industry, health environment, health insurance payer environment.
Understanding of Health benefits.
Preferred Qualifications
A High School Diploma or GED is required.
