Primarily responsible for assisting the Provider Relations Specialist in creating and maintaining a positive, professional and highly successful relationship with the Provider. The Provider Relations Coordinator will research and resolve issues sent to them by the provider Relations Specialists on behalf of the provider. The Coordinator will work with both Providers and Internal CDPHP staff to communicate issue resolution. This incumbent will represent Provider Relations and in some cases other departments within Internal Operations at internal meetings, projects, teams, and committees to provide those areas with the necessary tools to maintain relationships and implement strategies.
High school diploma or GED required, Associates degree preferred.
Minimum of 5 years of direct business-to-business experience in health care administration developing comprehensive business relationships with providers across multiple managed care business lines.
Strong experience with written communication to providers and solid understanding of technology and reporting required for contracting and network strategy and maintenance.
Must have experience in hospital, ancillary and physician claims payment, coding and other system pricing details.
Working knowledge of medical and facility coding knowledge, including CPT, ICD-9, and HCPCS is required.
Excellent internal relationship building skills and ability to perform in a matrix organization.
Proficiency in Microsoft Word, Excel, PowerPoint and Access.
Must possess thorough knowledge of contracting structures and payment methodologies and a strong understanding of regulatory requirements and measures, such as HIPAA, HEDIS, and other state and federal programs.
Subject matter expert in healthcare regulations, DOH/DOI – as they relate to providers, CDPHP business, fee schedules, CDPHP Policies and Procedures, desk levels and CDPHP contracts.
Strong technical background, with the ability to write technical specifications documents (BRDs, FSDs, Provider Manual).
Thorough understanding of state and federal regulatory requirements and submission needed.
Comprehensive understanding of Commercial, Medicare and Medicaid reimbursement methodologies and rates required.
Salary Grade: 15
CDPHP - 19 months ago