The Associate Provider Relations Representative supports provider outreach and education related to provider compliance with health plan operations and regulatory requirements. Interacts regularly with team members and key internal stakeholders in understanding provider requirements and challenges and develop processes needed to ensure success of department goals. This position builds and maintains positive working relationships with providers, effectively communicating with and educating those providers about the organization, provider responsibilities and resolving provider inquiries.
Duties and Responsibilities:
Responsibilities include, but are not limited to:
- Handle mandatory provider training tracking and outreach processes. Run reports out of Salesforce, review and follow-up as needed.
- Add, update, and maintain provider data in accordance with internal policies and procedures
- Ensure provider email distribution lists are accurate and up to date
- Handle Provider Relations requests from other departments by triaging and/or resolving issues timely
- Ensure Salesforce reporting captures requirements needed for training and other PR interactions
- Perform follow up on any provider non-compliance related to access and availability surveys
- Perform other outreach or tasks as needed to support provider education and compliance
- Assist in finding opportunities for provider training and education
- Work collaboratively interdepartmentally to resolve provider issues to ensure an adequate and satisfied provider network
- Respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
- Assist in finding opportunities to improve the provider experience and participate in implementing provider satisfaction initiatives
- Orient providers on Neighborhood’s policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and procedures
- Support Provider Relations team with the development and maintenance of strong professional relationships with providers while functioning as a liaison to the provider community
- Participate in departmental and interdepartmental meetings as appropriate and necessary
- Participate in the development of departmental policies, procedures and processes
- Maintain professional growth and development
- Represent organization at provider related events and other initiatives, as necessary
- Other duties as assigned
Qualifications Required:
- Bachelor’s degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience
- Experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)
- Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
- Ability to interact well with individuals on all levels, and maintain a professional image and attitude
- Ability to manage data and processes in multiple platforms
- Ability to work cross-organizationally to achieve the goals of the company and department
- Ability to work independently
- Detail oriented, with the ability to organize and ability to handle multiple projects simultaneously
- Excellent Customer Service and communication (written and verbal) presentation and facilitation skills
- Strong analytical and problem-solving skills
- Possess a general understanding of provider and claim operations as they relate to health plans
Preferred:
- Understanding of provider’s reimbursement methodologies and contract terms
- Experience with facility or professional provider relations
- Experience in SharePoint
- Experience with commercial, Medicaid or Medicare reimbursement mechanisms
- Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Skills Required
- Bachelor's degree in Health Administration, Business Administration, Public Health, or a related field, or equivalent education and experience
- Experience with a managed care organization or healthcare-related organization, such as an HMO, Medicaid, or Medicare organization
- Intermediate to advanced proficiency in Microsoft Office, including Word, Excel, and Outlook
- Ability to interact effectively with individuals at all levels while maintaining a professional image and attitude
- Ability to manage data and processes across multiple platforms
- Ability to work cross-organizationally to achieve company and department goals
- Ability to work independently
- Detail orientation, organization, and ability to handle multiple projects simultaneously
- Excellent customer service, written and verbal communication, presentation, and facilitation skills
- Strong analytical and problem-solving skills
- General understanding of provider and claims operations related to health plans
- Understanding of provider reimbursement methodologies and contract terms
- Experience with facility or professional provider relations
- Experience using SharePoint
- Knowledge of commercial, Medicaid, or Medicare reimbursement mechanisms
- Knowledge of quality improvement processes, such as Lean or Six Sigma
What We Do
Neighborhood Health Plan of Rhode Island (NHPRI) is a mission-driven, not-for-profit 501c3 health maintenance organization (HMO) insurance company. The organization provides nationally-recognized, high-quality health insurance and healthcare coverage to over 150,000 residents of Rhode Island, focusing on delivering affordable health care, wellness, and high-quality medical services to its members.
