The Sr. Contracting & Provider Relations Representative will be primarily responsible for the contracting and management of relationships with key medical groups, hospitals and ancillary providers as assigned. This position will act as the main contact for contracting, contracting questions, education as well as a liaison between the provider and the health plan to present, promote and resolve clinical and administrative concerns of providers. This position will be asked to handle the bigger and more complex provider negotiations as well as being a leader for other Contracting & Provider Relations Representatives.
The Sr. Contracting & Provider Relations Representative will work to build a network of providers in assigned areas to insure Plan members have the best access to care for all services as possible while still managing unit cost.
The Sr. Contracting & Provider Relations Representative will collaborate with other interdepartmental areas to design, develop and implement provider programs and initiatives to increase community interest, understanding and goodwill for providers. They will be asked to lead projects from time to time and will assist the Manager or Director in developing strategy for their entire region or state.
REQUIRED EDUCATION AND EXPERIENCE
- Maintain and document regular contacts, both by telephone and face to face visits with key providers and act as a liaison to internal departments to resolve complex issues
- Resolve incoming escalated provider inquiries daily
- Represent Care Improvement Plus externally, delivering professional and polished image by phone and in person regularly to educate and establish working relationships
- Handle contracting duties with key physician, ancillary, and hospital providers as assigned
- Assist with expansion or re-contracting efforts as part of Plan’s strategic goals
- Assure that executed contracts and associated paper work is complete and processed timely according to department policies and procedures
- Implement, in collaboration with other departments, provider relations programs to facilitate effective provider communications and enhance provider satisfaction and ultimately member satisfaction
- Create and maintain timelines to help ensure the timely implementation of the interventions, activities, etc. to support the organizations business model and providers.
- Assist in the creation of high quality analysis deliverables, such as work flow diagrams, policies and procedures, project timeline documents and throughput reports related to assigned providers.
- Ensure that processes are being appropriately documented to support ongoing operations.
- Assist interdepartmental areas in maintaining an accurate and complete updated provider database as well as ensure new provider contracts are entered accurately
- Interact with other departments to ensure closure of paperwork flow, especially as it relates to credentialing, re-credentialing, contract loading, and claim processing.
- Handle larger and more complex provider negotiations and relationships
- Lead assigned projects as well as leader for Contracting and Provider Relations Representatives
- Perform other duties as assigned
REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
- Bachelor's degree or equivalent combination of education and related experience.
- Minimum of 5 years experience in Contracting and Provider Relations in a managed care setting, health plan, hospital or large medical group practice is required
- Experience in face to face contract negotiations and provider servicing preferred .
- 2 years of hospital contracting experience
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
- Experience with Medicare programs preferred.
- Excellent administrative, analytical, organizational, verbal and written communication and presentation skills are required
- Proficiency with MS Office Suite
- Excellent customer service skills are required
- Professional image and behavior are required
- Ability to work with others while completing multiple tasks simultaneously and successfully is required.
- Proven leadership and project management skills
- Understanding of DRG, APC, and CPT code reimbursement
- Extensive out of office travel may be required
- Desire to move into management
XLHealth - 2 years ago
UnitedHealth Group unites its health plans with consumers across the US. A leading health insurer, it offers a variety of plans and services...