Description

SUMMARY

The Provider Relations Specialist is responsible for field and office activities in providing education and supporting the IPA’s providers network. The Provider Relations Specialist will be working with contracted providers on managed care operations and to comply with IPA and Health Plan standards.

An individual with at least two (2) years’ experience in managed care in handling provider network scope of services. The individual must have an understanding of Managed Care Operations (i.e., patient referrals, claims process, eligibility information, contracting, HEDIS, HCC etc.).

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Maintain professional etiquette at all times, especially when working with Providers.
• Must be able to have effective interaction with providers.
• Responsible for New Provider and office staff orientations and continued education of existing providers to ensure company programs and initiative (i.e., P4P, HCC, Encounter, etc.) and process is being effectively communicated. Ensure provider is effectively utilizing company tools available to them.
• Ability to handle provider concerns in an empathetic and caring manner (i.e., authorization, claims, compliances, etc.)
• Must be able to problem solve and identify ways to address provider issues effectively.
• Develop collaborative relationships with Doctors, Office staff, Health Plan representatives.
• Participate and conduct provider network administration functions including but not limited to: provider status changes, internal reporting, member transfers, and data reports distribution to contracted providers.
• Internal network liaison for other departments (i.e., Data Management, Claims and Quality Management Departments.)
• Report to management on what provider network needs and how to further enhance the organization.
• Highly motivated and able to work with multiple teams simultaneously.
• Facilitate meetings with contracted providers, health plan, and marketing events.
• Must be able to travel frequently to assigned service area.
• Other duties assigned by department Director.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

**Bilingual is preferred.

EDUCATION and/or EXPERIENCE

• An undergraduate degree from an accredited institution of higher learning required; or minimum of three (2) years relevant work experience in Network Management, Provider Services in a managed care setting, health plan or large medical group administration.
• Excellent oral and written communication skills.
• Detail oriented and possess strong organizational skills in a fast-pace environment.
• Proven in MS Office programs (i.e., Excel, Word, Outlook and PowerPoint)