Physician Services Liaison
Tampa Office Grade M
Reports to Debbie Tillman
This position performs in an “Account Management” structure and is responsible for the highly professional management and servicing of assigned Primary Care Physicians and Specialists that are critical to AvMed’s success. Among the Physician Accounts and/or groups that are assigned will be those that are diverse, complex, leveraged in the market, and demanding. The Physician Services Liaison will be well versed in AvMed products, contracting standards, policies/processes, claims and medical platforms; and be able to explain and educate their providers on each. The Physician Services Liaisons will be able to communicate and receive complex information, resolve even the most difficult issues in a timely and accurate manner; and, as necessary, will be resourceful in accessing internal business partners to assist in expediting a resolution and/or promote or educate on a new policy or procedure. They will be able to present their information convincingly and competently. The Physician Services Liaison will be service driven, proactive in educating, training and messaging; and at all times exemplify AvMed values of collaboration, respect, ethics, and accountability. Their goal for their “physician accounts” will be that they demonstrate high quality, and a cost-effective delivery of medical services to AvMed members, while maintaining high membership and satisfaction. The Physician Services Liaison will take ownership of their “provider accounts”; they will be passionate about serving them; and their physician accounts will recognize them as outstanding service leaders and superior to the competition.
ESSENTIAL JOB FUNCTIONS:
•Maintain a thorough operational knowledge of contractual agreements between AvMed and the assigned physicians.
•Facilitate identifying and recruiting physicians in the assigned geographies for participation with AvMed; evaluate the performance and composition of the physicians in conjunction with the Manager and Contracting team; and make recommendations for improvements.
•Seek continuous feedback from the Manager, Contracting Negotiators, Provider Service Center reps on negotiations and/or interactions and share same and gained reconnaissance from field meetings.
•Organize and facilitate timely outreach opportunities including orientations for all newly contracted physicians, training on applicable system capabilities including the online Provider Website, educating on new policies, and updating on AvMed’s client groups, membership, and accomplishments.
•Schedule regular F2F meetings that are well planned and cover the agenda items set forth for discussion for the Quarter by the Manager with the key decision-makers with the group or facility.
•Seek the involvement of an AvMed Medical Director to provide regular feedback on quality and cost performance of the Physician or Group.
•Establish schedule for periodic follow up for procedure updates and trouble-shooting issues as well as for maintaining open lines of communication.
•Maintain thorough knowledge of all State and Federal laws, which directly relate to the servicing and operations of providers and ensure compliance with such.
•Act as a service liaison to internal committees in order to improve provider language and template contracts for re-negotiations and future contracting.
•Analyze servicing over time to ensure appropriate interaction that will continuously improve provider satisfaction.
•Monitor and attend all Special Claims projects meeting, coordinate the preparation of documents and findings and ensure the appropriate AvMed staff are in attendance for a successful meeting and conclusion.
•Assist AvMed Health Plans in registering provider in electronic claims processing.
•Maintain visit-tracking logs, meeting visit standards and goals as set by AvMed and the Department Management.
•Ensure encounter forms, monthly reports, weekly schedules and other reports are submitted timely and in accordance with department standards.
•Ensure that potential terminations and terminations and/or panel transfers are communicated and planned for in a timely and efficient manner.
•Coordinate among the appropriate internal business partners for the timely and effective performance of all field investigations and resolutions or member service problems as requested.
•Responsible for ensuring that member's complaints are resolved in a timely and effective manner (as appropriate).
•Recognize and observe all departmental and company policies and procedures.
•Maintains a professional appearance by complying with the dress code in an appropriate manner.
•Bachelor degree required; although, an exception may be considered with a commitment to pursue and obtain a Bachelor’s degree within a specified period of time; and/or, the experience is extensive and shows strong results and high performance by the individual.
•Minimum of three years experience in direct contact with physicians/facilities and office staff, e.g., as Provider Relations Representative.
•Knowledge of the South Florida market place, its provider networks, and managed care dynamics.
•Strong knowledge of medical claims, CPT-4 coding and hospital and ancillary billing practices.
Demonstrated performance in:
•Exemplary planning, analytical, organizational and communication (both verbal and written) skills.
•Extensive knowledge of claims processing, procedures, and system capabilities.
•Knowledge of medical office management processes, and general medical practice procedures including coding.
•Superior problem identification and effective problem resolution ability.
•Passion for exceptional service excellence and commitment to total quality management and continuous quality improvement.
•Competency in computer programs including Excel, Word processing, database, presentation and spreadsheet skills commensurate with job requirements.
•Demonstrated ability to follow-through on projects and initiatives and stay the course, despite obstacles and challenges.
•Sound Operational understanding of legal content and structure of physician agreements.
AvMed Health Plans is a Drug/Tobacco Free Workplace EOE