Provider Relations and Contracts Service Specialist

HealthPartners•Bloomington, MN

1d•Hybrid

About The Position

HealthPartners is hiring a Provider Relations and Contracts Service Specialist. This position is the key resource to assigned primary care groups, specialty care groups, hospitals and/or other medical providers (“providers”) participating with the organization’s health plan networks. To maximize the efficiencies and quality of our provider relationships, this position will act as a facilitator to resolve provider inquiries and will assist provider staff in understanding and implementing new and existing HPI products, policies, procedures and systems. This position plays a key role in contract support through fee schedule and contract implementation.

Requirements

Bachelor’s degree
Three to five years of managed care experience in a member service, medical management, provider relations, or claims position
Strong verbal and written communication skills
Excellent problem identification and problem-solving skills
History of establishing diplomatic working relationships with providers and co-workers
Intermediate level PC skills
Strong organizational skills and ability to work independently
Current, valid, unrestricted Driver’s License (in the state of residence) free of major traffic violations or a pattern of repeated violations for the last 3 years and daily access to a reliable, insured vehicle

Nice To Haves

Four years of provider relations experience in a managed care setting (HMO, PPO)
Provider perspective as evidenced by two years experience in a healthcare setting

Responsibilities

Provide excellent customer service to assigned providers by: Researching and addressing questions related to provider payment, network participation, plan products and programs, and administrative policies and procedures
Serving as liaison between HPI and assigned providers to resolve member concerns in a timely manner
Guiding new provider groups through the onboarding processes necessary to join the HPI network
Preparing and coordinating legal contract documents in accordance with the Minnesota Department of Health, government programs, accreditation, and other regulatory agency requirements
Supporting the coordination and implementation of new strategic provider partnerships for designated HPI products with use of a work plan and teamwork with other key HPI departments.
Providing pro-active and on-going communication and education to designated provider staff regarding HPI products, policies, procedures, and systems.
Research, prepare, and communicate provider demographics, network set-up, and reimbursement rates to other departments to ensure internal operations reflect the most current provider information.
Participate in contract negotiation meetings, identifying administrative requirements necessary for successful implementation of legal contracts.
Collaborate and problem-solve with internal HPI departments to improve administrative efficiencies that will allow the providers to successfully deliver care to HPI members, to improve contracting opportunities for cost savings and/or to improve administrative interfaces.
Complete special projects that are identified through provider relationships, HPI Directors, Contract Managers, or Contract Consultants.
Devising administrative policies and online tools for provider use
Updating provider resource materials, including new product information documents
Coordinating the implementation of electronic connectivity programs
Creating new provider reports
Streamlining internal processes that involve several internal departments
Developing and implementing audit procedures to determine that contracts have been implemented correctly on the HealthPartners claims processing system