Provider Relations Representative I, Michigan

Provider Relations Representative I

We are looking for a Provider Relations Representative I, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.

Position Summary

Responsible for the education and servicing of assigned provider groups regarding all aspects of the Plan and its subsidiaries. Responsible for assisting in the development of policy, procedures and educational materials for use with all Provider Programs and for the development of benchmarks to measure performance against the Plan's goals. Establishes and maintains effective relationships with key physicians and office staff of contracted medical delivery entities (i.e. provider offices, specialists, etc.). Responsible for contracting of PCP's, Specialists, and Ancillary providers in their defined servicing area. Responsible for claims research and resolution. All duties are to be carried out in collaboration with the contracting staff and other key senior staff as appropriate.

Equal Opportunity Employer of Minorities / Females / Disabled / Veterans

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Qualifications

Required : High School Diploma / GED. Two (2) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care claims operations or provider billing functions. Valid state driver's license, reliable transportation, and automobile insurance coverage required and maintained throughout employment.

OR

• Equivalent combination of two (2) years' college coursework and experience in Managed Care claims operations or provider billing functions. Valid state driver's license, reliable transportation, and automobile insurance coverage required and maintained throughout employment.

Preferred : Associate Degree in business, health care or related field. Two (2) years' experience in contracting and / or servicing hospitals and / or physician organizations and their office staff Established relationships with providers in the Plan's service areas.

Additional Information