Provider Relations Representative Position Available

 

Liberty Health Advantage

 

Senior Provider Relations Representative

 

 

Position Summary

 

Responsible for network development, provider education and credentialing activities.  Facilitate communication between contracted providers and LHA.  Identifies, responds to and assists in resolving or coordinating the resolution of provider related issues. 

 

Position Accountabilities and Performance Criteria

 

1.Establishes and maintains effective communication with providers to establish positive working relationships, through direct interface and collaborative efforts.  Identifies problematic situations, performs data collection and develops solutions to correct network related issues.  Interfaces with providers concerning various critical issues, including, but not limited to: provider complaints, member issues/complaints, claims resolution, network termination, inactivation of provider numbers, authorizations, and pre-certification.  Documents and forwards sensitive issues, with resolution steps, to management and/or complaints and appeals unit, as appropriate.  Documents disposition of issue(s) to appropriate parties and copies to provider file in a timely manner. Interfaces effectively with other departmental and interdepartmental staff.

 

2.   Performs and documents site surveys during the credentialing and recredentialing process. 

 

3.Responsible for the initial orientation of newly credentialed providers, large group practices and follow-up educational visits, and ad hoc meetings, as appropriate.  Maintains standards regarding visits as outlined in departmental policies, procedures, and work flows, including documentation.  Frequency of visits/encounters and documentation pertaining to the visit are defined by departmental policies/procedures. 

 

4.  Educates new and existing providers concerning contractual issues.  Participates in provider education information development and updates, collaborating with other departments within the organization.

 

5.Assists in network development and marketing, working closely withmanagement to identify potential candidates for the provider network.

 

6.Actively participates in maintenance of the provider database(s) by receiving and communicating/documenting changes to appropriate parties.  Routinely monitors database(s) to assure accuracy, reporting changes to appropriate data entry sources.  Produces varied reports as needed/requested.

 

7.Prepares and maintains provider files and reports encounter information as defined in departmental policies, procedures and work flows.

 

8.   Perform financial analysis of claims, including preparation of spreadsheets and other documents. 

 

9.Assists in the development, redesign, and implementation of departmental work processes, policies and procedures.

 

10.  Projects a positive, supportive attitude toward company, management, and other Staff.



11.  Performs other duties as required/requested.

 

Position Qualifications

 

Minimum Education

High School Diploma

Associate Degree or higher preferred

 

Minimum Experience

At least two (2) years of experience in Provider Relations.

 

Spanish speaking preferred.