Provider Relations Representative

US-NY-New York
1 week ago
Job ID
2017-10891
# Positions
1
ArchCare at SNP
Experience (Years)
1
Category
Administrative
Work Days Per Week
5
Shift
D
Shift Start Time
9:00am
Shift End Time
5:00pm
Type
Full-Time
# Hours
7

Overview

This position provides support in the recruitment, implementation and servicing of individually contracted providers and vendors. Additionally, the position is accountable for training and orientation of providers in contracted areas. Position requires an understanding of reimbursement methodologies, negotiation strategies, and provider service experience in a managed care environment.

Responsibilities

.
* 
Conducts new provider orientation, education and ad-hoc re-education. Train providers and their office staff on contractual requirements and CSNP Policies and Procedures, and notifies all provider of changes to contracts or policies. New provider orientation to be completed within 15 business days of the effective date of the agreement.
* 
Assist provider offices in filing claims electronically.
* 
Assist in collection and processing of credentialing material when needed.
* 
Manage effective provider-specific action plans and process improvement initiatives.
* 
Work on end-to-end provider claim and call quality.
* 
Identify and remediate operational short-falls.
* 
Serves as liaison between provider network and all departments in CSNP.
* 
Assists in the investigation and response of complaints regarding providers or provider services. Adheres to required response time as outlined in policy and procedures.
* 
Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals.
* 
As required by changing business needs, complete additional responsibilities as assigned.
* 
Compliance with all ArchCare policies.

Qualifications

Education & Experience

 

Formal Education: Associate Degree or certification equivalent
 

 

 
Experience Requirements
*
2 years health care or managed care experience required
*
Knowledge of Medicare/Medicaid programs and reimbursement methodologies

 

Experience Desired
*
3 years health care or managed care experience
*
Specific Provider Relations, Network Development experience preferred
 
 

 

 

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