What are the responsibilities and job description for the Provider Relations Representative position at Neighborhood Health Plan of RI?

Job Details

Job Location Smithfield, RI - Smithfield, RI Position Type Full Time Education Level Bachelors Degree Travel Percentage Daily Job Shift Daytime Job Category Professional / Experienced

Description

This position is responsible for cultivating, maintaining and strengthening relationships with the provider community. In this highly visible field position, the provider relations representative acts as the primary liaison between the organization and its providers including primary care practices, specialists, physician organizations, hospitals, ancillary and long term services and supports providers. Primary responsibilities include establishing positive working relationships with providers, effectively communicating with and educating those providers about the organization and resolving provider inquiries.

Duties and Responsibilities :

Responsibilities include, but are not limited to :

Develop and maintain strong professional relationships with providers and their staff while functioning as a liaison to the provider community to research and resolve complex provider issues
Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and other events
Identify opportunities for provider training and education
Orient providers on Neighborhood's policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and procedures;
Take ownership of the provider relationship, ensuring all provider needs and concerns are addressed and resolved
Work collaboratively departmentally and inter-departmentally to resolve provider issues to ensure an adequate and satisfied provider network
Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
Identify opportunities for improving the provider experience and participate in implementation of provider satisfaction initiatives.
Work collaboratively departmentally and inter-departmentally to resolve provider issues to ensure an adequate and satisfied provider network
Participate in departmental and interdepartmental meetings as appropriate and necessary
Participate in the development of departmental policies, procedures and processes
Maintain professional growth and development
Represent organization at provider related events and other initiatives, as necessary
Responsible for complying with Neighborhood's Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and / or unethical conduct by fellow co-workers, professional affiliates and / or agents
Other duties as assigned

Qualifications

Qualifications- Required :

Bachelor's degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience

Two (2) years' experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)

Two (2) years' direct application of coding, billing and reimbursement mechanisms

Two (2) years' experience with facility or professional provider relations

Experience with commercial, Medicaid or Medicare reimbursement mechanisms

Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)

Ability to interact well with individuals on all levels, and maintain a professional image and attitude

Ability to manage data and processes in multiple platforms

Ability to work cross-organizationally to achieve the goals of the company and department

Ability to work independently

Demonstrated knowledge of billing practices and reimbursement methodologies

Detail oriented, with the ability to organize and ability to manage multiple projects simultaneously

Excellent Customer Service Skills

Excellent written and strong business communication skills (written and verbal) public relations, presentation and facilitation skills

Strong analytical, problem solving and project management skills

Understanding of provider and claim operations as they relate to health plans

Understanding of provider's reimbursement methodologies and contract terms

Must be able to travel within an assigned territory on a daily basis

Qualifications- Preferred :

Understanding of claims operations

Experience in Cognos

Experience in MedInsight

Experience in SharePoint

Experience with commercial, Medicaid or Medicare reimbursement mechanisms

Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)

American Academy of Professional Coders (AAPC) certification

Apply for this job

Receive alerts for other Provider Relations Representative job openings

Provider Relations Representative

What are the responsibilities and job description for the Provider Relations Representative position at Neighborhood Health Plan of RI?

What is the career path for a Provider Relations Representative?

Job openings at Neighborhood Health Plan of RI

Not the job you're looking for? Here are some other Provider Relations Representative jobs in the Smithfield, RI area that may be a better fit.

We don't have any other Provider Relations Representative jobs in the Smithfield, RI area right now.

AI Assistant is available now!