Senior Provider Relations Representative

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies. Health Net’s mission is to help people be healthy, secure and comfortable. The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

 

JOB SUMMARY:

 

Under direction, the Senior Provider Relations Representative maintains working relationships with network practitioners and key provider groups as assigned. This position is responsible for assuring accurate provider data, and providing training, education, and information to providers. Acts as the Company liaison to providers, communicating MHN's policies and procedures. May provide guidance or expertise to less experienced associates. Assesses provider-training needs. Assures compliance with contracts.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:Researches, analyzes and resolves claims, benefits, issues and authorization inquiries within delegated authority. Interprets MHN’s policies and procedures. Provides interpretation and clarification of benefits, eligibility, and access to care requirements. Escalates recurring or critical issues as appropriate to management. Assesses provider-training needs. Conducts appropriate training programs and/or orientations for assigned provider staff.Monitors provider database of current data relating to provider information. Ensures provider directories are accurate.Investigates compliance issues, identifies root cause, trains provider office staff on correct procedures, and provides written report of findings and recommendations.Meets on a regular basis with assigned key provider groups to cultivate and strengthen relationships. Supports the retention of providers by participating in meetings, conducting research, and supporting provider credentialing. Assists management in tracking, trending and reporting on provider recruitment and retention.Provides support on special projects and performs other duties as needed or assigned.Researches, analyzes and resolves claims, benefits, issues and authorization inquiries within delegated authority. Interprets Health Net’s policies and procedures. Provides interpretation and clarification of benefits, eligibility, and access to care requirements. Escalates recurring or critical issues as appropriate to management. Assesses provider-training needs. Develops, implements, and conducts appropriate training programs and/or orientations for assigned provider staff.Monitors provider database of current data relating to provider and physician information. Ensures provider directories are accurate.Investigates compliance issues, identifies root cause, trains provider office staff on correct procedures, and provides written report of findings and recommendations.Meets on a regular basis in person or by telephone with assigned key provider groups to cultivate and strengthen relationships. Documents office visits and provider issues on shared drive log.Supports the retention of providers by participating in meetings, conducting research, and supporting provider credentialing. Assists management in tracking, trending and reporting on provider recruitment and retention.Provides support on special projects and performs other duties as needed or assigned.

REQUIREMENTS:

 

Education:

Bachelor’s Degree in Health Care Administration or related field preferred.

 

Certification/License:

 

Experience:

Minimum three years experience in provider relations, provider contracting; health plan operations or health care/medical office environment.

 

Knowledge, Skills & Abilities:Must be accurate and detail orientedMust have strong oral and written communication skillsProficient with Microsoft Office (Word, PowerPoint and Excel)Possess knowledge of state and federal health care regulations, coding, medical terminology, claims processing and provider billing

 

 

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

 

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.