Senior Provider Relations Professional Jobs

Consulting services knowledge and experience.

Communicative: Articulate in spoken and written format in 1x1 and 1-to-many forums with analysts, senior executives, and experienced subject matter experts.

Strong analyst relations or communications experience with analyst firms such as Gartner, Forrester, IDC, and others.

Healthcare benefits including medical & prescription drug coverage, dental, vision, and mental health & well being

Diverse and inclusive employee resource groups, giving & volunteer opportunities, and discounts on retail products, services & experiences

Relationships: Builds trusted and enduring relationships with analysts and IBMers of all personalities and work styles.

Produces/generates various reports to management and provides feedback on activities to management.

Bachelor's degree OR Four (4) years of job-related work experience OR Four (4) years combined job related education and experience.

Four (4) years of experience in customer service, claims processing, communications, education/training, provider relations, healthcare or combination. (Can be concurrent)

Develops/prepares/reviews/updates all provider education materials.

Performs administrative functions in support of education and training.

Demonstrated skills related to training materials development.

Exceptional written and verbal communication and relationship management skills

Ensure compliance with Louisiana's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes

Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and/or regulatory requirements

Develop and maintain Behavioral Health provider relationships to optimize provider experience and satisfaction

Experience working with behavioral health providers and substance use providers

Understanding of behavioral health managed care and how services are delivered

Ability to manage multiple priorities with excellent organizational and problem-solving skills

Education & Licenses and Experience

Former experience as a NP or PA a plus

Strong relationships building skills, with proven ability to build and maintain partnerships with HCPs / Opinion Leaders, and internal team

Proven ability to manage organizational complexities and breadth of issues

Strong oral and written communication skills

Excellent communication and interpersonal skills to effectively engage in consulting and project management.

Solid knowledge of employment laws (EEO, ADA, AA, FMLA, etc.) and other regulatory/statutory requirements.

Bachelor's degree in Human Resources, business, or a related field (or equivalent experience).

Experience with HRIS, preferably PeopleSoft.

Local candidates encouraged to apply

Regularly communicate with division leaders and participate in leadership meetings to align HR efforts with business objectives.

Prepare and maintain up-to-date enrollment workflows consistent with requirements of specific implementations.

Pull and distribute monthly reporting per requirements of individual provider contracts.

An active Counseling License (OMSAS) or Substance Use Disorder Certification (Pennsylvania Certification Board) is strongly preferred.

Previous experience (2+ years) working in the SUD (addictions) profession

Knowledge of substance use disorders; if in recovery, at least 2 years of sustained recovery

Excellent oral and written communication skills, organizational skills, and high attention to detail

Assist in continual training to assigned providers on best practices and other resources to assist with claims, authorizations, member benefits, etc.

Strong communication skills and ability to use appropriate tact and finesse when dealing with delicate issues

Strong organizational skills to coordinate new partnerships and keep processes moving

Ability to think outside the box and offer new suggestions for integrating new procedures

Experience working in a healthcare, provider or HMO/PPO environment familiar with billing claims and authorization processes

Position Responsibilities may include, but not limited to

Proactive, analytical relationship management expert

Strong organizational and planning skills to manage multiple priorities and meet required deadlines

Access to continual education through CareMax University

Experience working with VBCs (value based contracts)

Minimum of three (3)– years of provider network operational experience

Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully

Detailed orientated problem solver with excellent time management skills and ability to meet filing due dates

Associates Degree in Health Administration, Business Administration, Regulatory Science or an equivalent combination of education and work experience in related field.

Two to three years of experience working in health insurance and regulatory industry

Strong writing, communication and interpersonal skills

Health insurance industry experience preferred

Participate in oversight calls with PPO Networks and vendors to coordinate regulatory compliance and document meeting minutes that meet regulatory guidance.

Proactive, analytical relationship management expert

Strong organizational and planning skills to manage multiple priorities and meet required deadlines

Access to continual education through CareMax University

Experience working with VBCs (value based contracts)

Minimum of three (3) – years of provider network operational experience

Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully

WORK STYLE: Mostly remote work, with minimal travel for meetings, conferences, and/or trainings

Very rarely will before/after hours, nights, weekends, holidays, or overtime be offered and will not be required.

Experience within the dental field/industry (ie clinical experience, billing experience, front office/reception experience, sales/marketing experience, etc)

Proactive thought leadership/Root Cause problem resolution skills

Excellent oral and written communication skills

Ability to multi-task, manage multiple projects, and meet deadlines

100% Remote/ Work from Home

·The main purpose of this role is to reschedule all canceled appointments either by patient are provider.

·Strategize, coordinate, create and execute Provider schedules efficiently and effectively.

·The Candidate must be comfortable making 200+ outbound calls a day and working in an independent environment.

·Reschedule all appointments canceled either by patient are provider.

·Establish concierge level relationships with assigned providers.

Requirements For a Provider Relations Manager

Experience in marketing, sales, or networking

OUR IDEAL PROVIDER RELATIONS MANAGER

Public Speaking Abilities Are Preferred.

Customer service driven - Eager to help customers find solutions regardless of challenges

Respectful - Treats others with kindness and is positive and helpful

Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.

5-8 years experience in a Provider Relations role for a managed care plan.

Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.

Solid knowledge of health plan operations required.

Assists with network strategy committee meeting and network application processing decision committees

Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.

High school diploma, GED, or equivalent work experience

Initiates phone calls to customers, (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings, and to request action.

Provides timely response and resolution for all provider initiated inquires (phone calls, emails or faxes).

Reviews and analyzes documentation and claim data to determine validity and proper action.

Updates accounts receivable system with denial and group information.

Assists with high priority special projects

Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.

5-8 years experience in a Provider Relations role for a managed care plan.

Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.

Solid knowledge of health plan operations required.

Assists with network strategy committee meeting and network application processing decision committees

Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.

Effective communication skills with all levels of management and organizations.

Highly organized and strong project management skills with attention to detail and accuracy.

Experience with CRM & Event Management platforms such as CVENT, Salesforce, Speakcore is desired.

Deliver excellent customer experience for clinicians and ensure strong communication with internal stakeholders, resulting in above benchmark customer feedback.

Generate regular reporting and dashboards to track educational event activity and effectiveness.

Balance simultaneous projects, manage multiple stakeholders, and establish and maintain relationships with both internal and external stakeholders

Servicing email requests from providers and maintaining categorized responsibilities of incoming emails.

1-3 years of related experience (clinical dental office experience and/or dental insurance/claims experience)

Knowledge of CDT codes and processing policies

Superior customer service and communication skills

Strong attention to detail and organizational skills

Responsible for maintaining the contracts and credentialing processes for all network dentists per NCQA, Medicare Advantage and DDPA’s standards.

Data Entry/plan build experience in Healthcare Insurance systems

This is a remote role

Bachelor’s degree or equivalent work experience preferred

Configure new clients and inforce client changes in the platform

Conduct initial and final validation of platform, client portal and census, as needed

Collaborate with resources to ensure issues are addressed and corrected prior to production completion

Ability to manage multiple priorities with excellent organizational and independent problem-solving skills

Education & Licenses and Experience

Previous experience implementing thought leader plans and professional medical society and patient advocacy strategies for pharmaceutical organizations

Strong relationships building skills, with proven ability to build and maintain partnerships with HCPs / Opinion Leaders

Proven ability to manage organizational complexities and breadth of issues

Strong oral and written communication skills