What are the responsibilities and job description for the Provider Relations and Contracting Specialist position at Group Health Cooperative of Eau Claire?
Position Purpose
The Provider Relations and Contracting Specialist is responsible for the overall maintenance and administration of provider contracts and associated documents including education materials. The Provider Relations and Contracting Specialist will also assist the Director of Member and Provider Relations, Executive Director of Operations, Senior Provider Relations and Contracting Specialist to coordinate with provider questions regarding contracting and procedure; analyze, research and provide resolution to billing/claims issues presented by internal and external customers.
Essential Position Functions
The Provider Relations and Contracting Specialist is responsible for the overall maintenance and administration of provider contracts and associated documents including education materials. The Provider Relations and Contracting Specialist will also assist the Director of Member and Provider Relations, Executive Director of Operations, Senior Provider Relations and Contracting Specialist to coordinate with provider questions regarding contracting and procedure; analyze, research and provide resolution to billing/claims issues presented by internal and external customers.
Essential Position Functions
- Ensure the maintenance of contract data and vendor updates/changes into the Provider Data management system is up-to-date.
- Participate in the clerical aspects of the contracting process, including but not limited to, specific contracts, amendments, addendums, letter of agreements, and terminations.
- Triage incoming calls, emails and faxes to the Provider Relations department for urgency, processing and forwarding to the Coordinator and/or Manager.
- Maintain the Provider Data management system for providers, clinicians, facilities and clinics.
- Assist with analyzing claims data and provider fee schedules.
- Create and maintain supplier and location information in database. Email notification to departments upon receipt of a signed vendor contract or change in contractual arrangement.
- Act as a liaison with Provider Services & Claims staff to assist with claims and billing related issues with direction and oversight from Director of Member and Provider Relations.
- Assist the department staff in updating, maintaining, and distributing provider manuals and updates.
- Maintain provider contract files electronically to include provider correspondence, contracts, and vendor add/change forms.
Minimum Requirements of the Position
- Associate degree in paralegal or related field or equivalent experience.
- Three to four years of experience in an office environment as a paralegal, claims processor, contracting, Contracting, or similar.
- Knowledge of Medicare, Medicaid and the insurance industry is beneficial.
- Proficient in Microsoft Word and Excel and have working knowledge of PowerPoint.
- Excellent oral and written communication skills and strong interpersonal skills.
- Strong organizational and data analysis skills. Must be able to prioritize and meet deadlines.
Group Health Cooperative of Eau Claire complies with applicable Federal civil rights laws and does not discriminate, exclude or treat candidates less favorably on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
