According to department policy and procedure, the Provider Relations Representative 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 processes, as related to providers, and contract management. Contract management includes fee schedules, claims questions and other network related subjects. Successful candidates 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.
Manages the provider relationships using policy,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.
Develops training materials, Power Point Presentations, etc. for use in 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 identifies patterns of problems with payors that need to be addressed.
Uses tact and diplomacy to communicate issues and resolution of issues to provider.
Participates in team meetings to maintain an understanding of payor and group administration and, as requested, acts a 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 duties as assigned.
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 and ability to present to large and small groups.
Ability to lead a team on special projects and multitask in a fast paced environment. The 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 and able to occasionally stay overnight.
Valid Washington State Drivers' License and access to automotive transportation with little notice.
Please submit your resume to firstname.lastname@example.org .
Additional information about our company may be found on our website
First Choice Health Network - 2 years ago
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