Provider Relations Representative
First Choice Health - Seattle, WA

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PROVIDER RELATIONS REPRESENTATIVE
SEATTLE Location
Come work for First Choice Health in Seattle –
Make it your First Choice!!

COMPANY INFORMATION:

First Choice Health is a Seattle-based, physician and hospital-owned company serving Washington and the Northwest since 1985. We now serve well over one million people with our array of products and services. Our Preferred Provider Organization (PPO) is recognized as the leading independent PPO in Washington State and has a growing regional presence in Oregon, Idaho, Montana and Alaska.

We occupy a great downtown location, pay competitive salaries and offer a comprehensive benefits package including medical, dental, vision, health savings accounts, flexible spending accounts, life and disability insurance, EAP, 401(k), profit sharing, tuition reimbursement, transportation assistance, credit union and gym membership discounts.

POSITION SUMMARY:
According to department policy and procedure, acts as a primary liaison between FCH and the contracted providers. Primary responsibilities include maintaining and enhancing provider relationship with strong communication about internal FCH process (related to providers) and contract management. Contract management includes fee schedules, claims questions and other network related subjects. Must have a strong knowledge of FCH payor clients (groups who rent the network and have access to the provider’s contract) and how those relationships work in order to educate and work effectively with the providers on payor issues.

EXAMPLES OF DUTIES:

  • Manages the provider relationship using policy and procedure, and professional experience to accurately respond to providers’ questions. Questions may include claims or accounts receivable issues, internal FCH process issues, or payor issues.
  • Responsible for visiting provider facilities to educate facility staff on topics such as billing, referral authorization of usage of FCH reference materials.
  • Works in a team environment, across departments, to resolve provider issues, and create and implement provider education and communication tools.
  • Documents new or changing policy and procedures, updates the Provider Manual and communicates changes to effected parties as necessary.
  • Provides training to newly contracted providers on the business procedures of FCH. Development of training materials, Power Point Presentations, etc. for use of Provider presentations to billing staff as needed.
  • Works directly with payor counterparts to solve payor problems with the provider.
  • Assists provider in monitoring their A/R with FCH payors and identify patterns of problems with payors that need to be addressed.
  • Uses tact and diplomacy to communicate issues and resolution of issues to provider.
  • Participant in team meetings to maintain an understanding of payor and group administration; as requested, acts as department representative in internal work teams.
  • Supports other FCH departments in resolving provider and or contract issues.
  • Actively pursues and maintains an understanding of the healthcare market.
  • Responsible for understanding claims data and communicating to various audiences.
  • Represents Provider Relations at various provider seminars and conferences throughout Washington, Alaska, Oregon and Idaho.
  • Other related duties as required.

QUALIFICATIONS:

  • BS/BA preferred or equivalent combination of work experience and education.
  • 5+ years experience in a provider “environment.” May include working in provider relations, contracting, or in a clinical setting.
  • Proven ability, through job experience, to understand the complexity of claims processing and contract management.
  • Strong written and verbal communication; ability to present to large and small groups.
  • Ability to lead a team on special projects, and multitask in a fast paced environment. Ability to meet deadlines and organize work is required.
  • Strong confidence with using a variety of computer software, including but not limited to Word and Excel. Some Access experience desired.
  • Ability to travel up to 20% of the work time; may require occasional overnight stay.
  • Valid Washington state driver’s license, and access to automotive transportation with little notice.

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