Provider relations rep

Corewell Health • Southfield, MI

3d • Onsite

About The Position

Under supervision of Director, Provider Relations oversees workflow and coordination of Provider Relations projects that support Beaumont Health facilities & affiliated physicians with both Managed Care plans and the Employee Health Plan Provider Network. Assist Sr. Provider Relations Representatives as appropriate to complete implementation of key Managed Care & Beaumont Health Employee Health Plan related projects and communications, both written and oral. Ensure tracking of key data provider data elements are accurate and kept current. Planning and organizational skills are extremely important in this position and must demonstrate a strong commitment with respect to exceeding customer expectations as well as resolving issues with a high level of tact and understanding. Must interact effectively as a team member and demonstrate a capacity for management of multiple projects and shifting deadlines.

Requirements

• Associate’s degree in business or related field.
• 1 year of relevant experience
• A minimum of one year experience in third-party provider enrollment.

Responsibilities

• Track and maintain provider data in Managed Care Contracting system software.
• Work with third party payers on behalf of providers to help facilitate the enrollment and participation process.
• Work with payers on roster generation and audits to ensure both parties have accurate, current information on participating providers and required data elements.
• Educate, and facilitate the process, for providers to become an Oakwood ACO member.
• Track current Oakwood ACO membership in Managed Care Contracting system software.
• Work with providers to explain payer requirements for enrollment and process to become a participating provider, including distribution of any provider material as needed.
• Communicate updates and changes of known payer processes that will impact providers.
• Assist with maintaining the Employee Health Plan Provider Network via routine reconciliations of contracted providers and communicating any needed changes with current Third Party Administrator (TPA).
• Assist in ensuring provider satisfaction through education and training, problem resolution and provider relations activities.
• Identify issues and coordinate problem resolution for physicians, hospitals and their support staff.
• Investigate and facilitate resolution of managed care related issues; involves complex and unusual issues requiring creative problem-solving skills.
• Assist with communication of critical information to providers, including financial models, contractual terms/, obligations and payer plan updates through bulletins, newsletters and other media.
• Aid System Director and Sr. Provider Relations Rep. in oversight and completion of special projects; performs all other duties as assigned.
• Aid Sr. Financial Analyst with special projects as needed.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree