Provider Relations Analyst

Cook Children's Health Care System•Fort Worth, TX

2d•Onsite

About The Position

This position will report directly to the Manager of Provider Relations. This position will be the focal point for providers and provider offices by acting as the liaison between the physician community and the Provider Relations staff. This includes maintaining effective relationships with the physician community, including but not limited to physician education, facilitation and resolution of complex, urgent problems. Must be familiar with Texas Medicaid, claims resolution as well as coordinating and facilitating Provider and committee meetings, create and publish Newsletters, notifications, monitor MCO notices, resolve Provider complaints, update and audit Provider website, update codes on prior authorization look up tool and special projects as assigned by Provider Relations and Network Management Director. Must maintain emails/CRMs for Provider Relations inbox.

Requirements

Bachelors Degree preferred but will consider 10 years healthcare/provider and/or member services experience in lieu of degree.
1-2 years experience in a provider or member services role working with state regulatory agencies preferred.
Familiarity with the provider community.
Experience presenting in a public setting and public speaking is desired.
Medical billing and Healthcare industry knowledge a plus.
Basic understanding of CHIP & STAR benefits, and NPI/TPI relationships for billing.
Working knowledge of HMO business operations specifically member services, claims, credentialing and plan operations.
Experience with Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).

Nice To Haves

Familiarity with Texas Medicaid
Familiarity with claims resolution

Responsibilities

Act as the liaison between the physician community and the Provider Relations staff.
Maintain effective relationships with the physician community.
Provide physician education.
Facilitate and resolve complex, urgent problems.
Coordinate and facilitate Provider and committee meetings.
Create and publish Newsletters and notifications.
Monitor MCO notices.
Resolve Provider complaints.
Update and audit Provider website.
Update codes on prior authorization look up tool.
Complete special projects as assigned by Provider Relations and Network Management Director.
Maintain emails/CRMs for Provider Relations inbox.