Job Objectives : The Provider Relations Radiation Therapy Specialist is responsible for performing activities pertaining to Provider Relations. The employee assists providers with the policies and procedures related to the CareCore National healthcare management program. The employee must have the ability to interact with a diverse group of providers and office staff. The specialist will work in conjunction with the Radiation Therapy Department in the co-ordination and education of providers who perform this specialty.
Provider Representative (include, but are not limited to):
1. Establish and maintain working relationships with CareCore direct/health plan contracted providers and their office personnel. Serves as a point of contact for providers for orientation, training and ongoing technical support for CareCore Managed Programs.
2. Resolve provider issues, including claims research, root cause analysis and resolution of system load issues or provider billing errors. Coordinate with other departments to resolve provider issues.
3. Abide by all compliance requirements for the Department of Insurance (DOI), Agency for Health Care Administration (AHCA) and the Centers for Medicare and Medicaid Services (CMS) as these apply to the Provider Relations Department activities.
4. Responses to provider requests/needs and identify trends and gaps as it relates to provider questions and concerns.
5. Negotiate provider contracts as applicable.
6. Schedule and conduct provider visits.
7. Provide input for the provider manual.
8. Communicate operating policies and procedures in the interaction with contracted providers and adhere to these policies and procedures.
9. Provide support relative to credentialing and re-credentialing activities as applicable.
10. Assist with execution of CareCore National and contracted physicians efficiency enhancements such as converting providers to electronic billing, remittance advice and payment or working with providers to move them from fax interactions to web or phone.
11. Participate in the development and implementation of procedures that will facilitate and/or improve services provided to CareCore National and contracted physicians.
Radiation Therapy Specialist:
Co-ordinate educational meetings with Radiation Therapy providers to review policies and procedures of the program as well as resolve claim issues. Be able to discuss the program, coding, MND requirements, worksheets, treatment plans and ASTRO guidelines. The specialist will send out the invitations, create an agenda and establish an attendee list with guidance from the Radiation Therapy Department.
Perform other work-related duties as requested.
Minimum Requirements: A Bachelor's Degree or an equivalent combination of education, training and experience is necessary. Two years of Coding ( CPT-4 and ICD-9) experience with a Radiation Therapy concentration. Knowledge of contracts and healthcare claims. Proficiency in using a personal computer to enter/access information to generate reports is necessary. Have the ability to make presentations, as required, to Health Plans or providers. Previous Provider Relations experience within a managed health care environment is desirable.
- 2 years ago - save job
eviCore healthcare (eviCore) is a medical benefits management (MBM) company committed to making a positive impact in healthcare. Our...