The Provider Relations Representative acts as the primary operational liaison providing collaborative account maintenance and oversight ranging in scope from staff education to proactive troubleshooting. The Provider Relations Representative also functions in a capacity that contributes to the stabilization of the Provider Network. They monitor and report the level of Provider satisfaction and provide support to the Provider Network Development Department.
Key Functions and Responsibilities:
Required Competencies and Qualifications:
- Performs initial orientation of network Provider(s) and Provider staff. Provides general education and support on AlohaCare products and policies to Providers and coordinates office and provider meetings.
- Serves as liaison for all reimbursement, credentialing claims, EDI web site procedures and issues. Facilitates resolution of contractual and member/Provider issues, collaborating with all internal departments related to the resolution of Provider issues.
- Meets with assigned providers regularly and proactively identifies for education and performance improvement opportunities through interactions and/or feedback from AlohaCare staff.
- Coordinates and executes administrative meetings with providers and/or office staff as needed with the help of the Provider Network Development Department.
- Manages the implementation of new provider contracts to ensure all necessary information is collected and analyzed so providers can be credentialed, loaded in systems and notified within standards set by department.
- Analyzes operational issues with regard to territory providers and compliance to AlohaCare programs and policies and assist in the development of solutions.
- Acquires and demonstrates a thorough knowledge of territory provider operations including interrelationship among other area providers.
- Assists with recruitment of key providers to join AlohaCare network including coordination and distribution of recruitment packages.
- Monitors and communicates Medical and BH managed care market trends and issues.
- Assists in the development and distribution of Provider communication material.
- Maintains the integrity of Provider data in QNXT.
- H.S degree and 1-2 years administrative and customer service experience.
- Microsoft Office, Outlook, and Internet skills.
- Excellent customer service skills.
- Understanding of claims analysis, managed health care and provider billing practices
- Eager to give input in improving product or processes.
- Able to work independently, outcome focused and deadline driven, accurate.
- Committed to excellence, demonstrates corporate core values is critical.
- Adheres to organizational competencies based on corporate values and culture
AlohaCare - 17 months ago