What are the responsibilities and job description for the Representative-Provider Relations position at Baptist Memorial Health Care?
Overview
Purpose of Position and Scope of Responsibility
Participates in all appropriate aspects of development of BHSG networks and products to ensure the network of healthcare providers meets customer quality, access, and cost requirements. Acts as a liaison between the provider and the various health plans and/or payers. Performs provider orientations and delivers ongoing education in order to develop and maintain rapport with the providers and support staffs and to enable problem-solving and contract compliance. Performs other duties as assigned.
Principal Accountabilities/Responsibilities
Maintains working knowledge of BHSG provider contracts, fee schedules and health plan requirements to respond to customer needs regarding network issues.
Promotes retention of providers in the network through ongoing education, problem solving and resolution of provider grievances in order to promote accessible patient care and adherence to the health plan requirements.
Receives provider inquiries, answers questions, interprets provider contracts, fee schedules, and health plan requirements, and solves payer-provider issues in a timely manner consistent with good customer service/relations.
Makes recommendations and provides support and assistance, both internally and externally, in the interpretation of multiple fee schedules, utilizing computer resources and technology to accomplish objectives.
Minimum Qualifications
Minimum Education
Bachelor's degree in health administration, marketing, or related field or equivalent experience.
Minimum Experience
Three (3) years customer service, practice management, sales, office administration or managed care experience.
Desired Qualifications
Desired Experience
4 years managed care experience.
Purpose of Position and Scope of Responsibility
Participates in all appropriate aspects of development of BHSG networks and products to ensure the network of healthcare providers meets customer quality, access, and cost requirements. Acts as a liaison between the provider and the various health plans and/or payers. Performs provider orientations and delivers ongoing education in order to develop and maintain rapport with the providers and support staffs and to enable problem-solving and contract compliance. Performs other duties as assigned.
Principal Accountabilities/Responsibilities
Maintains working knowledge of BHSG provider contracts, fee schedules and health plan requirements to respond to customer needs regarding network issues.
Promotes retention of providers in the network through ongoing education, problem solving and resolution of provider grievances in order to promote accessible patient care and adherence to the health plan requirements.
Receives provider inquiries, answers questions, interprets provider contracts, fee schedules, and health plan requirements, and solves payer-provider issues in a timely manner consistent with good customer service/relations.
Makes recommendations and provides support and assistance, both internally and externally, in the interpretation of multiple fee schedules, utilizing computer resources and technology to accomplish objectives.
Minimum Qualifications
Minimum Education
Bachelor's degree in health administration, marketing, or related field or equivalent experience.
Minimum Experience
Three (3) years customer service, practice management, sales, office administration or managed care experience.
Desired Qualifications
Desired Experience
4 years managed care experience.
