Provider Relations Rep I

Where compassion meets innovation and technology and our employees are family.

Thank you for your interest in joining our team! Please review the job information below.

GeneralPurpose Of TheJob:

The Provider Relations Representative servesas theliaison betweenhealth careprovidersandDriscoll Health Plan: responsible for provider facilityinitialorientation,ongoing education and problem resolution; performs officeinspection sitesurveys of newproviders.Conducts visitswith providersand their office staff on a routinebasisto ensureopen communicationbetweenhealth planandproviders.

Also ensures provider demographic informationis correct andup-to-date in assignedterritory.

Essential Dutiesand Responsibilities:

To perform this job successfully, an individualmust be able toperform each essentialdutysatisfactorily. The requirements listed below are representative oftheknowledge,skill,and/orabilityrequired. Reasonable accommodations may be madeto enableindividualswithdisabilitiestoperformthe essential

functions. This job descriptionis not intended to beall-inclusive;employeeswillperformother reasonably related business duties as assigned bytheimmediatesupervisorand/or administrationas required.

•Maintains utmostlevel of confidentiality at alltimes.

• AdherestohospitalandHealth Plan policiesandprocedures.

• Demonstrates businesspractices andpersonalactionsthatare ethical andadhereto corporate compliance and integrity guidelines.

• Communicates the benefits ofbeing a DHP provider.

• Providestimelyeducation toproviders and provider's staffconcerning contractrequirements, DHP provider manual, policies andprocedures,andclaim submissionguidelines.

• Provides timely educationtoprovidersandprovider's staffonDHP electronicsubmission of claims, Electronic Funds Transfer processes, and webportal functions.

• Establish goodworkingrelationshipswithprovidersandproviderofficesin resolving issues to include being a trusted advocatefortheprovider.

• Establishascheduleofprovider workshopstoinclude specialty specific education.

• Assistsproviderswith incentiveprograms, as applicable.

• Develop and implement a balancedscorecardmetric.

• AssisttheContracting andCredentialing Departmentsas necessary.

• Document provider callstoinclude an IssuesLogfor monthly reporting.

• Developandmaintain a process forprovidernotificationtoinclude physicianchanges(moves, leaves practice, join practice, etc).

• Communicates in both written and oralformwithcontracted professionals,individuals,on behalf of the physicians/Health Plan inordertoobtain orrelay information.

• Maintainsuptodate knowledgeof physiciancontracts,claims andbilling.

•Isdetailoriented with exceptionalpresentation skills,abilitytocomplete multipleprojects and meet deadlines.

• Maintains excellentverbaland writtencommunicationskills,proficientcomputer skillshelpful.

• Abilityto provide prompt, courteousand excellentcustomer service toproviders.

• Assists theCEO, CFO,Medical Director's).Directors, or otherstaff as needed.

• Performs otherduties asrequested

Education and/orExperience:

Licensure:Validdriver'slicenserequired.

Two years'experience inhealthcare, medicalprovideror customer relationsrequired.

Minimum of 3years' experience ina Provider Relationsrole,preferablywithahealthplanor provider network preferred.

At least a highschool educationwith college degree preferred.

OtherKnowledge/Skills:

Computer skills withPCsoftware, especially MicrosoftOfficeproducts.

Must be able to projecta professional, pleasantimage while interacting withavariety of personalities.

Should havestrong written and verbal communication skills and be adept at persuasion and problem solving.

Ability to plan and prioritize to achievegoals.

Must be abletounderstand andexplain policiesandoperational proceduresof theorganization.