Maintaining the FirstCare Health Plans provider network to ensure quality service to the members. This includes contracting, site visits, handling a variety of issues and communication. Assisting with the preparation of manuals, directories and reports for all products.
ESSENTIAL DUTIES and RESPONSIBILITIES:
EDUCATION and/or EXPERIENCE:
- Coordinate and conduct orientations for newly contracted physicians and other providers.
- Maintain working knowledge of plan EOC's and procedures and is able to communicate this information to the physician and provider offices.
- Serve as consultant to the Medical Department on provider issues.
- Serve as liaison between providers and health plan, maintaining consistent communications with physicians and providers, including policy changes and updates.
- Plan, coordinate and conduct large and small group provider meetings and training sessions as necessary.
- Participate in local medical community organizations as public relations effort.
- Assists with the development and monitoring of provider contracts.
- Resolves administrative problems affecting network providers, patients, and plans within contracted guidelines for which the network is responsible.
- Initiate and maintain effective channels of communication with Provider Relations Team in the Regions.
- Manages the establishment and continual updating of provider demographic and billing information.
- Coordinates provider status information with member services and other plan departments.
- Performs other duties as required
FirstCare Health Plans is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, marital status, disability or any other basis prohibited by law.
- Bachelor’s degree (B.A.); and/or significant experience (usually 3+ years) working in a provider relations environment.
- Knowledge of managed care policies.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
FirstCare Health Plans - 23 months ago