Provider Relations Representative 1

JOB SUMMARY The Provider Relations Representative 1 is responsible for providing excellent customer service to providers, and providing timely and accurate responses to all provider concerns and issues.
Responsible for delivering adequate training and education to providers for all product lines.
Supports various operational management aspects of contracting and credentialing.
ESSENTIAL FUNCTIONS OF THE ROLE Develops and maintains trusting, personal relationships with providers and their office staff via office visits, telephone calls and correspondence.
Meets weekly provider contact goals and provides excellent customer service during each contact.
Serves as the liaison for providers and responds to all concerns and issues.
Works with internal departments to ensure providers have a complete resolution.
Delivers adequate education and training to providers and their office staff for all product lines including, but not limited to, conducting new provider orientations.
Assists the Credentialing Team by performing site visits/surveys as needed.
Identifies gaps in the network and works with the Network Development Team to find providers to fill the gaps.
Works with the Quality Improvement team on various HEDIS initiatives with the providers.
Facilitates information gathering for contract negotiations and reviews in order to expand provider networks and maximize cost effective care.
Participates in and refers financial negotiations of hospital contracts to financial offices.
Conducts periodic reviews and revises existing contracts in order to maximize cost effective care.
Proposes modifications to new contract language.
Collaborates with other departments to provide a systematic credentialing process for contracted providers and effective contracting based on cost and frequency of utilization; ensures contracted providers and services meet quality standards to deliver safe and effective patient care.
KEY SUCCESS FACTORS Knowledge of managed care and/or health insurance industry.
Proven relationship management skills.
Able to negotiate and revise contracts in order to maximize cost effective care.
Proven problem-solving and data-based skills.
Able to collaborate on process definition and improvement and ensure quality standards are met.
Able to multi-task, set priorities, and work autonomously with minimal supervision.
Able to travel at least 75% of the time Monday through Friday, including some overnight stay.
Excellent written and verbal communication skills.
BENEFITS Our competitive benefits package includes the following Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level QUALIFICATIONS EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification EXPERIENCE - 1 Year of Experience