Provider Relations Coordinator

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

1d•Hybrid

About The Position

The Provider Relations Coordinator serves as the primary liaison between Cook Children's Health Plan and its contracted physicians, hospitals, ancillary providers, and provider office staff. This field-based position is responsible for conducting onsite provider orientation, education, training, and relationship management activities to support provider engagement, operational excellence, quality improvement, and regulatory compliance. The Coordinator travels throughout assigned service areas to provide in-person education, deliver provider performance scorecards, resolve operational issues, communicate health plan initiatives, and ensure providers have the tools and resources necessary to successfully participate in the provider network. This role requires a highly motivated, professional, and outgoing individual with strong presentation skills, knowledge of Texas Medicaid and CHIP, and the ability to build effective provider relationships. The Provider Relations Coordinator is responsible for performing all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for the tracking of concerns, complaints and issues raised by network providers, and results reporting. Facilitates resolution of all complaints/issues raised by network providers related to members, claims, operational policies and organizational procedures. Responsible for ensuring the accuracy and completeness of CCHP provider directory information. Coordination of the development and publication of the CCHP provider newsletter. Development & maintenance of the CCHP provider reference guide. Develops and implements additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.

Requirements

High School graduate with advanced training in healthcare, business, or a related field required.
Five (5) years of operational experience in a managed care organization specifically in the area of provider network management to include provider orientation, ongoing educational activities, problem resolution and provider communications required.
Previous experience with face-to-face visits to provider offices and traveling to designated providers offices based on territory assignments/counties required.
Experience preparing and presenting information to individuals and groups.
Proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
Must be attentive to detail, have excellent organizational, problem solving, verbal and written skills.
Must be able to work independently and actively participate as an integrated team member.
Must maintain primary residence within the state of Texas.
Must maintain all licenses and credentials required for your position throughout your employment.

Nice To Haves

Experience with governmental managed care programs desired.

Responsibilities

Conduct onsite provider orientation, education, training, and relationship management activities.
Support provider engagement, operational excellence, quality improvement, and regulatory compliance.
Travel throughout assigned service areas to provide in-person education.
Deliver provider performance scorecards.
Resolve operational issues.
Communicate health plan initiatives.
Ensure providers have the tools and resources necessary to successfully participate in the provider network.
Perform all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs.
Track concerns, complaints and issues raised by network providers, and report results.
Facilitate resolution of all complaints/issues raised by network providers related to members, claims, operational policies and organizational procedures.
Ensure the accuracy and completeness of CCHP provider directory information.
Coordinate the development and publication of the CCHP provider newsletter.
Develop and maintain the CCHP provider reference guide.
Develop and implement additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.