Provider Relations Representative

Job Description

REQUIREMENTS

EDUCATION AND EXPERIENCE:

• High school diploma or equivalent is required
• Bachelors degree preferred
• At least two years of related experience with a payer or provider organization with responsibility for provider relations, provider credentialing, and/or provider information management required

KNOWLEDGE, SKILLS AND ABILITIES:

• Computer Proficiency Demonstrated proficiency in the use of personal computer applications; specific skills to include Microsoft Word, Outlook, Excel v-lookup, and ability to build and compare files using NPPES data and provider taxonomy
• Interpersonal Skills Ability to quickly develop rapport and work effectively and professionally with all levels of personnel
• Problem-Solving Skills Ability to investigate/research problems and issues and to recommend associated corrective actions
• Discretion Ability to manage sensitive or confidential information in a professional and discreet manner

RESPONSIBILITES

• Assists in maintaining accurate Provider/Vendor records and Provider Directory
• Develop and evaluate the provider network to ensure appropriate access and availability for Health Plan membership
• Create and verify Provider Data integrity with on-going monitoring and responds to daily inquiries in a timely manner
• Educate and assist providers to maximize data integrity and provider experience
• Cultivates and maintains collaborative internal and external relationships to maintain and improve positive interpersonal relations and execute network strategies
• Responds timely to provider nominations by providing guidance and insight to leadership based on network need
• Actively participates and assists in meeting CMS guidelines and NCQA accreditation standards
• Assists in the on-boarding of new providers. This may include training and education to providers to ensure success in the program.
• Resolves Provider Inquiries via Provider Relations email, CRMs, Joint Operating Committees and surveys in a timely manner.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned

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