Provider Relations Representative recruits and completes contracts with providers, provides training, education and assistance to provider to ensure satisfaction and continued participation. Assists with payor, claim, data and other issues to assure satisfactory resolution. Contributes to team goals and projects and supports all other IPN areas as needed. Holds accountability for recruitment and provider resolutions in designated area or as assigned by management.
Recruitment of new providers to include sending applicable standard documents and negotiation of contract language and fees.
Review, prepare, and submit contracting and credentialing documents with timely follow-up to provider to obtain missing or incomplete documents.
Communicate effectively with providers by letter, email, phone or personal visit to inform of participation status, IPN policies, procedures or updates, or other information.
Schedule and complete Provider Education activities to include online webinars, individual office presentations, group and workshop presentations and general communication to providers to inform them of IPN and IPN Payor policies, procedures and updates.
Provide timely response to daily phone and email requests from providers for information, claims assistance, and other issues. Accurately document contacts and follow-up and ensure final resolution of provider issues within specified timelines.
Maintain data and contract files to include regular follow up with providers to ensure that IPN has accurate data for provider and contract files are current and in proper order.
- Actively participate in payor client, provider and team meetings as necessary.
- Provide back up to other provider relations representatives and other IPN team members as needed.
- Participate in all required training or department meetings.
- Contribute to provider newsletter periodically or as requested.
- Provide review and input for department contracts, documents and fee schedules as required for updates.
- Contribute to development and review of department policies and procedures. Meet department and company performance and attendance expectations.
- Perform other duties as assigned.
Work Experience: Minimum two years experience working in healthcare provider office or in a closely related health insurance area which provided exposure to provider practice routine, insurance billing and gathering patient billing information. Familiarity with provider community, PPO or similar health care environment as well as provider contracting preferred. Experience in public speaking and written communication to both internal and external customers is required.
Education, Certificates, Licenses: High school diploma or equivalent required. Bachelor’s Degree in Business or Health Care Administration preferred.
Knowledge: Effective written and verbal communication skills and professional telephone skills. Exceptional grammar, spelling, punctuation, consistency, proofreading, and editing skills. Must be proficient in Word, Excel, Powerpoint and Access. Demonstrated problem solving, organization, public speaking/presentation skills required. Knowledge of provider billing procedures, Medical Terminology and ICD/CPT coding and CMS claims requirements. Understanding of RBRVS and other fee schedule methodologies. Demonstrated ability to work independently and as a member of a team. Ability to analyze inquiries and determine steps for resolution.
- Building Customer Loyalty
- Building Strategic Work Relationships
- Continuous Improvement
- Building Trust
- Work Standards
- Contributing to Team Success
- Planning and Organizing
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We encourage creativity, innovation, and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity and affirmative action employer.
PacificSource Health Plans - 21 months ago
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