Associate Provider Relations Representative

Neighborhood Health Plan of Rhode Island•Smithfield, RI

11d•Onsite

About The Position

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.

Requirements

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

Nice To Haves

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)

Responsibilities

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