Provider Relations Representative 1

Job Description

Under the direction of the department supervisor, this position is responsible for assigned duties and activities in the Provider Relation Department to ensure an appropriate network of health care providers is available to our members. The Provider Relations Representative will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

• Professional, ethical, and respectable representation of BFMC to the Provider Community.
• Work directly with providers and staff to develop and facilitate efficient health care delivery network, resolve issues, and provide continued provider support.
• Work as both provider advocate and plan representative; answering questions, identifying and evaluating problems,communicating resolutions in a timely manner.
• Assist with conducting individual / group provider orientation sessions and follow up orientations with both prospective provider groups and participating physicians.
• Types provider related and departmental correspondence.
• Assist with periodic provider satisfaction surveys.
• Possess, and demonstrate full understanding of the various provider contracts maintained by BFMG.
• Responsible for maintaining and documenting all types of provider contacts in provider files.
• Assists with analyzing various reports to monitor provider activity and identify provider problems This may include assisting with developing and implementing necessary action plans.
• Assists in the development and preparation of various corporate and / or health plan required reports, which may include network analysis.
• Possess working knowledge of HPN Policies and Procedures.

Requirements

8.1 High School Diploma from an accredited school or equivalent and completion of 60 semester units or 90 quarter units from an accredited college or (Industry related training may be accepted as substitution).

8.2 Three (3) years provider relations or medical staff experience (Two (2) years of related managed care experience may be substituted for each year required).

8.3 Knowledge of provider relations, recruiting and credentialing requirements and procedures; contracting methods; medicalreimbursement methodologies.

8.4 Must be able to effectively communicate, both verbally and in writing; adapt to a stressful, rapidly evolving work environment; work independently and manage multi-task responsibilities; intervene in "challenging situations” on behalf of the BFMC or providers; deal with difficult people prioritize workload, make decision, resolve provider concerns, and effectively use various compute programs.

The pay range for this position at commencement of employment is expected to bebetween $32.41 and $38.13 However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.

Salary : $32 - $38