Provider Relations Representative
About The Position
Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Performs a variety of duties to assist in ensuring effective provider customer service. Fosters positive working relationships with providers, health plan payer and practice/hospital staff with regard to health plan policies and procedures, quality improvement initiatives and improving overall physician relations. Maintains effective contact with physicians, hospital staff, and others fielding inquiries, as well as informal and formal office visits, etc.
Requirements
- Bachelor’s degree in Business Administration or related discipline.
- Two to three years of relevant Managed Care experience.
- Knowledge of managed care principles and database applications.
- Excellent verbal and written communication skills.
Nice To Haves
- Knowledge of a variety of business applications software packages with proficiency in database software such as Access.
Responsibilities
- Assists in identifying issues requiring intervention and or communication to physician offices and hospital staff such as, managed care and/or health plan referral requirements, health plan related administrative and operational procedures, and quality improvement initiatives.
- Assists in resolving escalated provider issues based on standard policies and procedures while incorporating provider's feedback.
- Assists in developing and implementing a communication plan and follows up on physician and staff concerns.
- Works with physician/office staff to address issues and concerns related to hospital and/or health plan initiatives, policies and procedures or overall educational areas of improvement by through on-going dialogue with physician and hospital office staff.
- Assists in developing communications and educational tools for in service trainings, health plan forums, orientation updates, physician and office workshops, provider handbooks and news bulletins.
- Reports issues requiring intervention. Investigates causes for recurring problems and helps resolve hospital and physician issues.
- Works with Physician Enrollment and Credentialing office to prepare information for credentialing committees relating to new physician applications
- Works with database applications for reporting and assists in developing new reports to accommodate business reporting needs.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
