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- Provider Services Representative
- Provider Relations Manager – Chicagoland
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Provider Relations Representative Jobs
Company | Fallon Health |
Address | Worcester, MA, United States |
Employment type | FULL_TIME |
Salary | |
Category | Insurance |
Expires | 2023-07-30 |
Posted at | 10 months ago |
Overview
- Engage necessary Fallon Health staff members and conduct investigative research to resolve provider issues. Work collaboratively with internal partners to reduce provider issues and implement long term solutions to problems identified.
- Monitor and counsel providers on disciplinary actions and non-compliance issues.
- Assist in the development of provider training material and provider tools. Deliver provider training including new provider orientations, individual and/or group training on various healthcare administration topics, government compliance regulations and FCHP policies and procedures for products, benefits, claims, referral, and eligibility and utilization management.
- Serve as primary Fallon Health contact for providers to resolve issues relating to the administration and operation of providers' contracted services.
- 30-50% Travel is required.
- Escalate conflicts to Manager of Provider Relations and when appropriate Director, Provider Relations.
- Co-lead internal and external Joint Operations Committee meetings with contract managers.
- Develop and maintain positive and productive rapport with Fallon Health providers through proactive relationship management and communications.
- Orient and educate primary care, specialist, hospital, and ancillary providers by conducting physician and office staff visits. Educate providers on Fallon Health policies and procedures to include products, benefits, claims, referral and eligibility verification processes, utilization management guidelines, etc. Activities include conducting both individual and large group education sessions on a continual basis.
- Bachelor’s degree in related discipline with healthcare administration training highly desirable
- Valid Driver’s License and Clean Driving Record Required
- Exemplary customer relations skills.
- Proficiency with desktop computer applications, Microsoft Office package and Mainframe knowledge (i.e. QNXT, IDX etc.)
- Thorough knowledge of government regulations as dictated by regulatory agencies, including NCQA (National Committee on Quality Assurance) and CMS (Centers for Medicare & Medicaid Services).
- Training curriculum development and platform presentation techniques.
- 3-5 years’ experience
- Clear and concise written and verbal communication skills
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