Provider Engagement Representative

HealthOne Alliance-posted 3 months ago
Dalton, GA
11-50 employees
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The Provider Engagement Representative is responsible for servicing providers through public relations, problem solving, education, communication and support of Company policies and procedures. This role will provide education, training, and support for all providers. This position will also work to establish and maintain Medicaid CMO communications protocols, education, training, and schedules.

  • Works directly with providers to ensure they are serviced, maintained, and educated on all policies and procedures in an efficient and professional manner.
  • Manages collaboration with other departments and outside entities to meet identified needs of the providers and their patients, while also ensuring that other staff cooperate with these entities.
  • Provides positive, supportive communication to providers at all times.
  • Provides content for the Provider Insider Newsletter to ensure approved messages and communication comply with Provider Notification requirements.
  • Acknowledges any grievances and complaints within 1 business day of notice and resolves the issue within 30 days.
  • Assists with ensuring providers are compliant with the NCQA requirements regarding availability and access standards.
  • Facilitates provider surveys and communications required for NCQA compliance.
  • Provides education, coaching and guidance to providers regarding HEDIS measures, CMS programs and any other quality initiatives for members.
  • Gathers provider opt-in forms for various contracted entities that fall under HOA (Medicaid CMOs, Tricare, PHS/CI, etc.).
  • Assists Contracting, Credentialing and Network Management in loading new providers and completing contract/credentialing files.
  • Works with Network Management to ensure provider updates are sent for processing timely and ensures updates are performed accurately within the system.
  • Assists in research and problem resolution on issues related to claims processing incorrectly and works with the Claims Department to find resolution.
  • Reviews claim reports for denials and works with providers to improve claim submissions and provider data updates to ensure accurate claim adjudication.
  • Creates, audits, and distributes provider reporting as necessary.
  • Facilitates messenger model activities with health plan partners.
  • Encourages web-site and provider portal utilization through education and training to ensure providers can maximize the website and portal to best service their practices and patients.
  • Maintains provider and patient confidentiality at all times.
  • Keeps current in changes and trends that affect the Managed Care Industry.
  • Maintains regular and predictable attendance.
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
  • Works to encourage and promote Company culture throughout the organization.
  • Other duties as may be assigned.
  • Bachelor’s Degree in Health Care Administration, Nursing, Business, or related field preferred.
  • Valid Driver’s License.
  • Broad-based business experience within the healthcare/managed care environment.
  • 401K (4% Match, Immediate Vesting)
  • Accident insurance
  • Competitive salary
  • Critical Illness Insurance
  • Dental Insurance
  • Employee Assistance Program
  • Flexible Spending Account
  • Health & Wellness Program
  • Health Savings Account
  • Life & AD&D Insurance
  • Long Term Disability
  • Medical Insurance
  • Paid Time Off
  • Pet Insurance
  • Short Term Disability
  • Vision Insurance
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