Network Internal Representative

Community Health Network of Connecticut•Wallingford, CT

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Network Internal Representative to join our team. Primary Responsibilities: Under the supervision of the Manager, Provider Engagement Services (PES), performs data entry and systems maintenance for provider/hospital files in CACTUS/sProvider data management system. The Internal Representatives basic function is to support the External PES Representatives while they are onsite at Connecticut Medical Assistance Program (CMAP) network provider locations. Network Internal Representatives also update and maintain provider/hospital files in CACTUS/sProvider for the member/provider on‑line directory. Provide direct support in Member/Provider Financial Grievance resolution by reviewing member eligibility and claims. Outreach CMAP providers when members are billed and follow up with members via email on grievance resolution. Provide reporting support documentation. Performs other duties as assigned by the VP of Population Health and/or Manager of PES. Tasks Performed: Verifies, analyzes, and maintains all provider/hospital data in support of member/provider directory for assigned region(s). Daily duties include telephonic and email recruitment of instate and out-of-state providers through tasks sent by the Member Engagement Services Call Center. Performs telephonic and email recruitment of all Ordering, Prescribing and Referring (OPR) providers sent by DSS. Telephonic and email recruitment of Connecticut Medical Assistance Providers (CMAP) who are to re-enroll within 60‑days of DSS termination date. Telephonic and email outreach of CMAP providers that are terminated from the network to reenroll and track termination reasons. Monitor CRM for provider-related financial grievances and inquiries and provide a timely response if needed. Input data into CRM from Tasks and Grievances. Aid in the identification of Primary Care Providers (PCP) through PCP attribution reports and collaborating with the Quality Management Person-Centered Medical home team. Essential Functions: May be called upon to perform problem resolution and company operating policy guidance to hospital, physician, and other designated providers in the CMAP network. Must be able to adapt to a fast paced, changing work environment. The ability to update and query in CACTUS/sProvider is an important part of the job responsibility.

Requirements

Secondary schooling or vocational training
High school diploma or GED required
5 years related experience in Medicaid and associated administrative practices
At least 3 years of demonstrated proficiency handling customers and/or providers via telephone or electronic email.
Knowledge of the Connecticut health care delivery system.
Knowledge of Medicaid Program and demonstrated skills performing administrative practices (purchase vouchers, scheduling meetings)
Knowledge and ability to perform and learn various software programs.
Proficient with Microsoft Office suite including Word, Excel (including basic formulas, sorting, filtering, etc.), Outlook, PowerPoint, CRM, Interchange, and CACTUS/sProvider.

Nice To Haves

College level degree preferred
General studies; business courses preferred

Responsibilities

Performs data entry and systems maintenance for provider/hospital files in CACTUS/sProvider data management system.
Supports External PES Representatives while they are onsite at Connecticut Medical Assistance Program (CMAP) network provider locations.
Updates and maintains provider/hospital files in CACTUS/sProvider for the member/provider on-line directory.
Provides direct support in Member/Provider Financial Grievance resolution by reviewing member eligibility and claims.
Outreaches CMAP providers when members are billed and follows up with members via email on grievance resolution.
Provides reporting support documentation.
Verifies, analyzes, and maintains all provider/hospital data in support of member/provider directory for assigned region(s).
Performs telephonic and email recruitment of instate and out-of-state providers.
Performs telephonic and email recruitment of all Ordering, Prescribing and Referring (OPR) providers.
Performs telephonic and email recruitment of Connecticut Medical Assistance Providers (CMAP) who are to re-enroll within 60-days of DSS termination date.
Performs telephonic and email outreach of CMAP providers that are terminated from the network to reenroll and track termination reasons.
Monitors CRM for provider-related financial grievances and inquiries and provides a timely response if needed.
Inputs data into CRM from Tasks and Grievances.
Aids in the identification of Primary Care Providers (PCP) through PCP attribution reports and collaborating with the Quality Management Person-Centered Medical home team.
Performs problem resolution and company operating policy guidance to hospital, physician, and other designated providers in the CMAP network.
Adapts to a fast paced, changing work environment.
Updates and queries in CACTUS/sProvider.