Provider Relations Rep I

General Purpose Of The Job:

The Provider Relations Representative serves as the liaison between health care providers and Driscoll Health Plan: responsible for provider facility initial orientation, ongoing education and problem resolution; performs office inspection site surveys of new providers. Conducts visits with providers and their office staff on a routine basis to ensure open communication between health plan and providers.

Also ensures provider demographic information is correct and up-to-date in assigned territory.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential

functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required.

• Maintains utmost level of confidentiality at all times.

• Adheres to hospital and Health Plan policies and procedures.

• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.

• Communicates the benefits of being a DHP provider.

• Provides timely education to providers and provider's staff concerning contract requirements, DHP provider manual, policies and procedures, and claim submission guidelines.

• Provides timely education to providers and provider's staff on DHP electronic submission of claims, Electronic Funds Transfer processes, and web portal functions.

• Establish good working relationships with providers and provider offices in resolving issues to include being a trusted advocate for the provider.

• Establish a schedule of provider workshops to include specialty specific education.

• Assists providers with incentive programs, as applicable.

• Develop and implement a balanced scorecard metric.

• Assist the Contracting and Credentialing Departments as necessary.

• Document provider calls to include an Issues Log for monthly reporting.

• Develop and maintain a process for provider notification to include physician changes (moves, leaves practice, join practice, etc).

• Communicates in both written and oral form with contracted professionals, individuals, on behalf of the physicians/Health Plan in order to obtain or relay information.

• Maintains up to date knowledge of physician contracts, claims and billing.

• Is detail oriented with exceptional presentation skills, ability to complete multiple projects and meet deadlines.

• Maintains excellent verbal and written communication skills, proficient computer skills helpful.

• Ability to provide prompt, courteous and excellent customer service to providers.

• Assists the CEO, CFO, Medical Director's). Directors, or other staff as needed.

• Performs other duties as requested

Education and/or Experience:

Licensure: Valid driver's license required.

Two years' experience in healthcare, medical provider or customer relations required.

Minimum of 3 years' experience in a Provider Relations role, preferably with a health plan or provider network preferred.

At least a high school education with college degree preferred.

Other Knowledge/Skills:

Computer skills with PC software, especially Microsoft Office products.

Must be able to project a professional, pleasant image while interacting with a variety of personalities.

Should have strong written and verbal communication skills and be adept at persuasion and problem solving.

Ability to plan and prioritize to achieve goals.

Must be able to understand and explain policies and operational procedures of the organization.