Provider Relations Specialist

TakeCare Insurance Company • Tamuning, GU

9h

About The Position

Reports directly to the Provider Relationship & Network Contracting Manager and serves as the primary contact and liaison between TakeCare and contracted healthcare providers. This role ensures strong provider relationships, supports network operations, resolves provider concerns, and promotes compliance with contractual, regulatory and quality standards. Essential Duties and Responsibilities: Build and maintain positive and strong working relationships with physicians, hospitals, clinics and ancillary providers. Serve as the main point of contact for provider inquiries regarding contracts, claims, credentialing and policies. Educate providers on health plan procedures, reimbursement guidelines and network requirements Coordinates provider onboarding, orientation and training Support network development initiatives including recruitment, retention of providers and benchmarking. Resolve provider issues and escalate complex concerns when necessary Conduct provider site visits and performance review as required Monitor provider compliance with contract terms and regulatory standards. Collaborate with internal departments to include claims, credentialing, quality improvement and compliance. Maintain accurate provider records and documentation. Performance other duties that may be assigned from time to time.

Requirements

• Bachelor’s Degree or minimum of 5 years experience in managing relationship and communicating with vendor/client partners
• Minimum of 2 years experience in healthcare administration, provider relations or insurance operations.
• Ability to work independently and manage multiple priorities.
• Excellent problem solving and conflict resolution abilities.
• Effective team player. With very good interpersonal relationship skills and can work and relate well with co-employees, patients and customers.
• Must have behavioral sensitivity, maturity, diplomacy and tact in complex situations and handling irate customers.
• Outstanding oral and written communication skills.
• Strong ethics and a high level of personal and professional integrity.
• Must have basic familiarity with federal and state laws and requirements relating to healthcare management.
• Computer literate and very highly proficient in using MS office programs

Responsibilities

• Build and maintain positive and strong working relationships with physicians, hospitals, clinics and ancillary providers.
• Serve as the main point of contact for provider inquiries regarding contracts, claims, credentialing and policies.
• Educate providers on health plan procedures, reimbursement guidelines and network requirements
• Coordinates provider onboarding, orientation and training
• Support network development initiatives including recruitment, retention of providers and benchmarking.
• Resolve provider issues and escalate complex concerns when necessary
• Conduct provider site visits and performance review as required
• Monitor provider compliance with contract terms and regulatory standards.
• Collaborate with internal departments to include claims, credentialing, quality improvement and compliance.
• Maintain accurate provider records and documentation.
• Performance other duties that may be assigned from time to time.

What This Job Offers

• Job Type: Full-time