Provider Relations Rep I

Driscoll Children's Hospital•Corpus Christi, TX

About The Position

The Provider Relations Representative serves as the liaison between health care providers and Driscoll Health Plan. This role is responsible for provider facility initial orientation, ongoing education, and problem resolution. The representative performs office inspection site surveys of new providers and conducts routine visits with providers and their office staff to ensure open communication between the health plan and providers. Additionally, the role ensures provider demographic information is correct and up-to-date in the assigned territory. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required.

Requirements

Valid driver's license required.
Two years' experience in healthcare, medical provider or customer relations required.
Computer skills with PC software, especially Microsoft Office products.
Must be able to project a professional, pleasant image while interacting with a variety of personalities.
Should have strong written and verbal communication skills and be adept at persuasion and problem solving.
Ability to plan and prioritize to achieve goals.
Must be able to understand and explain policies and operational procedures of the organization.

Nice To Haves

Minimum of 3 years' experience in a Provider Relations role, preferably with a health plan or provider network preferred.
College degree preferred.

Responsibilities

Maintains utmost level of confidentiality at all times.
Adheres to hospital and Health Plan policies and procedures.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Communicates the benefits of being a DHP provider.
Provides timely education to providers and provider's staff concerning contract requirements, DHP provider manual, policies and procedures, and claim submission guidelines.
Provides timely education to providers and provider's staff on DHP electronic submission of claims, Electronic Funds Transfer processes, and web portal functions.
Establish good working relationships with providers and provider offices in resolving issues to include being a trusted advocate for the provider.
Establish a schedule of provider workshops to include specialty specific education.
Assists providers with incentive programs, as applicable.
Develop and implement a balanced scorecard metric.
Assist the Contracting and Credentialing Departments as necessary.
Document provider calls to include an Issues Log for monthly reporting.
Develop and maintain a process for provider notification to include physician changes (moves, leaves practice, join practice, etc).
Communicates in both written and oral form with contracted professionals, individuals, on behalf of the physicians/Health Plan in order to obtain or relay information.
Maintains up to date knowledge of physician contracts, claims and billing.
Is detail oriented with exceptional presentation skills, ability to complete multiple projects and meet deadlines.
Maintains excellent verbal and written communication skills, proficient computer skills helpful.
Ability to provide prompt, courteous and excellent customer service to providers.
Assists the CEO, CFO, Medical Director's, Directors, or other staff as needed.
Performs other duties as requested