Provider Relations Representative- Health Plan

Parkland Health

21d•Onsite

About The Position

The purpose of this position is to provide exceptional business service to our network of participating providers by serving as the primary liaison between providers and the health plan as well as identifying new providers to complement and expand the network. The Provider Business Consultant will execute onboarding, education, and outreach activities to ensure provider adoption, adherence and compliance with Parkland Community Health Plan (PCHP) quality management and accountable value based care programs. The Provider Business Consultant will continuously execute PCHP's network development plan to ensure best-in-class performance toward improving our quality of care, improving our patient experience, and reducing avoidable costs.

Requirements

High school diploma or equivalent.
4 years of provider support, education, relationship management or contracting experience.
3 years of claims, billing, coding or revenue cycle management experience.
Advanced knowledge of health care including managed care programs that administer Medicare and/or Medicaid.
Advanced level knowledge of provider reimbursement methodologies.
Advanced level knowledge of network development strategies, clinical integration and accountable value based care principles.
Expertise in gaining consensus and negotiating performance improvement plans.
Effective knowledge of the Texas Department of Insurance, the Office of the Inspector - - - General and other state agencies involving claims and Fraud, Waste and Abuse programs.
Functional knowledge of Current Procedural Codes (CPT), ICD-10, CMS 1500 professional claims, UB ancillary, and hospital clean claim guidelines.
Ability to utilize personal computer applications.
Advanced level written and oral communication skills.

Nice To Haves

Bachelor's Degree in healthcare related field.
Three (3) years of direct healthcare fee schedule and/or charge master maintenance experience.
Three (3) years of claims/billing systems maintenance and configuration.

Responsibilities

Serve as the primary liaison between providers and the health plan.
Identify new providers to complement and expand the network.
Execute onboarding, education, and outreach activities to ensure provider adoption, adherence and compliance with PCHP quality management and accountable value based care programs.
Continuously execute PCHP's network development plan to ensure best-in-class performance toward improving quality of care, patient experience, and reducing avoidable costs.