Provider Relations Representative

Volunteers of America National Services (VOANS)•Louisville, KY

About The Position

Maintain the provider network for assigned VOANS PACE Organization(s). Essentials: Develops and maintains strong relationships with healthcare and other service providers, including physicians, hospitals, clinics, and ancillary service providers. Initiates and maintains effective communication channels between contracted providers and PACE clinical and administrative teams to develop cohesive, high performing working relationships. Serves as the primary point of contact for provider inquiries, concerns, and escalations, ensuring timely resolution and follow-up. Collaborates with internal departments, including claims, contracting and credentialing, to resolve provider-related issues in a timely manner and ensure seamless service delivery. Exhibits understanding and sets priorities to handle multiple tasks simultaneously, and designs work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion. Completes orientations, training and development for new and existing network providers. Gathers, reviews, and verifies all pertinent information relating to participating network providers. Communicates with the Provider Relations Manager on provider updates, issues and concerns and collaborates on projects. Plans and facilitates meetings with current and prospective contracted providers. Works with contracted providers to adhere to contract and regulatory requirements. Monitors and prepares routine reports for the Provider Relations Manager on provider satisfaction and other provider metrics. Conducts proactive provider outreach, networking and education initiatives to promote PACE. Assists in the development of strategies for provider network expansion and growing enrollment referral streams. Prints, packages, mails or distributes in person company flyers, post cards and, educational materials for existing and prospective network providers. Travels within designated service area to provider offices and PACE Center as required in order to accomplish the position’s tasks. Stays informed about changes in healthcare regulations and company policies that may impact providers. Other duties as assigned

Requirements

Bachelor’s degree in Healthcare or Business Administration or closely related field.
Minimum two years in client services and provider relations.
Ability to communicate and work effectively with various levels of facility and VOA/VOANS staff and providers.
Analytical and organizational ability.
Self-motivated, disciplined, detailed and career oriented.
Integrity driven.
Knowledge of HIPAA law.
Knowledge of PACE regulations.
Knowledge of claims processes and data capturing.

Responsibilities

Develops and maintains strong relationships with healthcare and other service providers, including physicians, hospitals, clinics, and ancillary service providers.
Initiates and maintains effective communication channels between contracted providers and PACE clinical and administrative teams to develop cohesive, high performing working relationships.
Serves as the primary point of contact for provider inquiries, concerns, and escalations, ensuring timely resolution and follow-up.
Collaborates with internal departments, including claims, contracting and credentialing, to resolve provider-related issues in a timely manner and ensure seamless service delivery.
Exhibits understanding and sets priorities to handle multiple tasks simultaneously, and designs work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion.
Completes orientations, training and development for new and existing network providers.
Gathers, reviews, and verifies all pertinent information relating to participating network providers.
Communicates with the Provider Relations Manager on provider updates, issues and concerns and collaborates on projects.
Plans and facilitates meetings with current and prospective contracted providers.
Works with contracted providers to adhere to contract and regulatory requirements.
Monitors and prepares routine reports for the Provider Relations Manager on provider satisfaction and other provider metrics.
Conducts proactive provider outreach, networking and education initiatives to promote PACE.
Assists in the development of strategies for provider network expansion and growing enrollment referral streams.
Prints, packages, mails or distributes in person company flyers, post cards and, educational materials for existing and prospective network providers.
Travels within designated service area to provider offices and PACE Center as required in order to accomplish the position’s tasks.
Stays informed about changes in healthcare regulations and company policies that may impact providers.
Other duties as assigned