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Posted: Tuesday, September 12, 2017 1:43 PM

Job Description:/h3:
Position Summary:
Sr. Provider Relations Representatives are responsible for establishing and maintaining strong business relationships with provider types, ensuring each of their territory compositions include an appropriate distribution of provider specialties and provide in depth, high level educational instruction and support to physicians and their staff. This is an account management position and will be the main point of contact for the respective providers. Will routinely visit physicians offices for issues concerning the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets, education of benefits, policy and procedure for managed care plans, assistance with claims payments, financial compensation and marketing. Generally work is self:directed and not prescribed; works with less structure, but more complex issues. Travel requirements : local and extensive.
Responsibilities:
:Develop the provider network of assigned territory (family practice, cardiology, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produce a comprehensive product for business partners.
:Intermediary between Health Plans and Providers concerning provider participation, claim issues, additions, terminations
:Daily visits to physician offices
:Provide Orientations and ongoing education to physicians and staff on Health Plans policies, procedures and resource information
:Develop a strong relationship with office staff and physician to promote their growth in the network.
:Review bonus matrix with physicians for each quarterly distribution.
:Proven ability to synthesize and translate competitive intelligence into decision:making process
:Analyze Data to identify cost driver and share/educate physicians on improvement options
:Provide
advice/guidance/recommendations and insight to leadership regarding assigned network territory
:Negotiates provider contracts as applicable
:Participates in quarterly Provider Forums
:Serves as a resource to others.
:Assist staff with proper claims payment when necessary.
:Assist Health Plans and Physicians with HEDIS compliance and data collection
:Works with other departments on a daily basis
:Assist with special projects
Qualifications:
:4+ years of experience in Provider Relations with a Physician Network or Health Plan REQUIRED
:Knowledge of Medicare reimbursement methodologies REQUIRED
:Reliable transportation REQUIRED
:MUST live in the San Antonio area.
:Fluent in Spanish a plus.
:Knowledge of claims processing and guidelines a plus
:Strong interpersonal skills, establishing rapport and working well with others
:Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others (a critical thinker with presentation skills)
:Analytical/data drive decision:making skills
:Working knowledge of provider business operations
:Proven ability to synthesize and translate competitive intelligence into decision:making process
:Familiar with Microsoft applications including Outlook, Word and Excel. Experience with Access a plus.
:Must be self:motivated and work independently; able to translate concepts into practice
Company Benefits:
:In a full:time permanent position, you will be able to participate in our company benefit program which includes:
:Group benefits include medical, dental, vision, company paid 25k life with the option to add more voluntary life insurance coverage for employee and their family, STD, company paid LTD, 401k, and a variety of supplemental coverages such as hospital, cancer, legal, etc. available to the employee and their family.
:Employer funded HSA program.
:Paid Time Off ranging from 5:28 days depending

Source: https://www.tiptopjob.com/jobs/71845940_job.asp?source=backpage


• Location: San Antonio

• Post ID: 31058632 sanantonio
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