Provider Relations Representative, ACO (NTWKMGT/PR)
Universal American Financial Corp - Maryland

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At Universal American, we are dedicated to a Healthy Collaboration, working together with healthcare professionals in order to improve the health and wellbeing of our members.

We have an exciting opportunity to join our organization and be part of the implementation and operation of Accountable Care Organizations (ACOs) aimed at increasing care coordination, improving quality of care and reducing costs for Medicare members. ACOs are designed to provide Better Care, Improved Health and Lower Per Capita Costs. Improved health will be accomplished through prevention and chronic care management. The aim of the ACO is intended to reduce the trend of cost increases associated with the Medicare fee for service population.

The Provider Relations Representative will provide education, training, guidance, and other duties as assigned for providers in the assigned Accountable Health Organization (ACO) .

Develop strong interpersonal relationships with providers.

Strengthen and enhance the role of the provider relations representative with providers.

Develop and maintain effective working relationship with member services department, medical management department and sales and marketing departments.

Recruitment of providers identifying specific providers and small provider groups in the states/counties of their area assigned by the Network Administrator.

Follow up on issues identified by providers and their offices.

Work with Business Development Managers to identify areas to recruit providers.

Utilize software systems and databases to provide reports on activities to network administrators.

In conjunction with regional manager develop implementation plans for assigned areas of responsibility.

Assure that all responsibilities are performed consistent with the deliberate plans of the organization.

Represent the organization well at all times; support its mission, goals and objectives; participate as a “team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.

Maintain personal professional development.

Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.

And all other duties assigned by the manager and/or supervisor.

Required Skills

Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas

Organizational skills with the ability to handle multiple tasks and/or projects at one time

Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company

Analytical and interpretation skills including departmental, utilization, financial and operations data

Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization

Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements

Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time

Problem solving skills with the ability to look for root causes and implementable, workable solutions

Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs

Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience

Bachelor’s degree in business administration, related field, or applicable experience in a managed care organization

A minimum of 3 years provider relations experience in Medicare or Managed Care

Good knowledge of provider community in state

Knowledge of Medicare and how it is reimbursed

Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

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