Provider Relations Representative

Overview

Ensure all your application information is up to date and in order before applying for this opportunity.

Manages all aspects of provider relations within a specified geographic region. Regularly visits and maintains ongoing contact with existing / potential providers for relationship building, recruitment, credentialing, re-credentialing and assisting with provider issues and education.

Works under general supervision.

Compensation :

$30.71 - $38.41 Hourly

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals

What You Will Do

• Manages all provider contracts in designated territory, including recruitment, credentialing, recredentialing and relationship maintenance through regular visits and ongoing contact with existing and potential providers.
• Prepares materials for and orients providers to contract terms and operating requirements, Health Plan program and eligibility requirements, and service coordination.
• Collaborates with the Network Development and Contracting and Service Operations departments to administer demographic changes and renewals to provider contracts.
• Monitors contract performance of network providers and serves as a liaison between the Health Plan and the Provider to ensure the flow of information regarding resolution of member service issues.
• Coordinates provider site visits, as needed.
• Coordinates and attends meetings to serve as a resource and address provider issues.
• Updates and maintains provider manuals with current Health Plan policies and procedures.
• Updates and proofs provider directories.
• Assists providers in triaging billing and claims disputes.
• Participates and collaborates with Compliance on Department of Health and internal audits.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications :

Driver's license, required

Education :

Bachelor's Degree or equivalent related work experience, preferably in health care setting, required

Work Experience :

• Minimum three years health care experience, required
• Knowledge of government programs, including Medicare and Medicaid, preferred
• Prior experience in Provider Relations, preferred
• Reliable transportation to work sites, required

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