Provider Relations Specialist

SIHO HOLDING INC•Columbus, IN

1d•Onsite

About The Position

This is a non-exempt position. The Provider Relations Specialist has responsibility for network contracting with Professional and Ancillary providers and serving as the relationship coordinator for our PPO rental networks. The position also has responsibilities for researching and confirming credentialing information (work history, malpractice history, hospital privileges, etc.) on contracted providers. The Specialist loads both new provider information and all updates to current providers into the SIHO system and prepares files for SIHO Credentialing Committee review. Assisting our Sales, Account Management, Reinsurance, and Finance teams in understanding and quantifying our network strengths and weaknesses.

Requirements

Experience in a managed care organization preferred
Strong communication (oral and written) skills
Demonstrated problem solving and analytical skills
Knowledge of health insurance, billing, and/or claims processing
Ability to work at a self-directed pace in a changing, multi-task environment
Professional appearance and presence
Ability to project and maintain a positive attitude internally and externally
Intermediate understanding of Word, Excel, database, and web-based technology
Ability to maintain strict confidentiality
Must be good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools

Responsibilities

Prepare, execute, and maintain provider contracts with Professional and Ancillary providers, including renegotiation with current SIHO Network providers.
Function as the point-of-contact for all on-going contractual issues as needed by providers.
Negotiate Single Case Agreements (SCA) with non-participating providers as requested by Medical Management and Account Management.
Work closely with and provide support to Health Systems Development, Sales, and Account Management to provide network support for new business development initiatives.
Work with and provide support to Provider Services Specialists on contractual issues and to assure smooth and efficient operations.
Establish and maintain good relationships between SIHO and its network providers
Provide education to physicians, facilities, and ancillary providers
Training of newly contracted health care providers on SIHO’s policies and procedures
Recognize and handle potential issues appropriately
Handle issues within the Provider Services department internally and externally
Complete special projects as assigned by the Provider Relations Supervisor
Inform the Provider Relations Supervisor of important updates
Assist in creating new projects to streamline the functions of the department
Work with Provider Relations staff and internal/external customers to assure smooth and efficient operations
Credential and re-credential providers by utilizing verification sources
Enter and maintain provider load information in the SIHO system
Coordinate with PPO Networks, Data Management, Reinsurance, and Finance to ensure our networks competitiveness is appropriately reflected in our pricing.