Provider Relations Specialist
About The Position
Under the direction of the Manager of Contracting and Network Management, the Provider Relations Specialist assists with credentialing and provider relations activities for BFMG/HPN/CCPN. The role interacts professionally and courteously with other departments, clinic personnel, and outside providers to create and maintain positive relationships with internal and external customers. The position supports credentialing file maintenance, provider support, contract understanding, satisfaction surveys, and analysis of provider activity. It also helps ensure that credentialing practices meet the requirements of HPN, Inc., contracted health plans, NCQA, and applicable state and federal regulations.
Requirements
- High school diploma or GED equivalent.
- Credentialing experience; training will be provided if necessary.
- Excellent written and oral communication skills.
- Knowledge of correct grammar and English language usage, including punctuation.
- Familiarity with Microsoft Office.
- Ability to prioritize work and multitask.
- Ability to responsibly handle confidential matters.
Responsibilities
- Assist with updating physician credentialing files and information in the Morrissey Credentialing Database and Virtual Provider Database, ensuring the accuracy and timeliness of information entered by Medical Staff.
- Assist with maintaining provider and ancillary files by conducting quarterly audits of all files for BFMC/CCPN.
- Assist with revising and updating the Credentialing Program to meet the requirements of HPN, Inc., contracted health plans, NCQA, and state and federal regulations.
- Work with provider office staff to develop and facilitate an efficient health care delivery network, resolve issues, and provide ongoing provider support.
- Act as both a provider advocate and plan representative by answering questions, identifying and evaluating problems, and communicating resolutions in a timely manner.
- Support user setup for the online portal.
- Assist with periodic provider satisfaction surveys.
- Maintain and demonstrate an understanding of the various provider contracts.
- Assist with analyzing reports to monitor provider activity and identify provider problems.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
