Manages the relationship and all levels of operations support with network hospitals, skilled nursing facilities and participating Hospice providers. Provides ongoing education to facilities regarding health plan operations. Identifies and implements process improvements and enhancements.
REPORTS TO: MANAGER, PROVIDER RELATIONS
DEPARTMENT: HI PROVIDER RELATIONS-STATE
POSITION LOCATION: KAPOLEI, HI 96707
- Establishes and maintains strong business relationships with hospitals in assigned area.
- Responds in a timely fashion to identified concerns.
- Plans and facilitates hospital meetings as needed.
- Designs and implements programs to build and nurture positive relationships between the health plan, providers (hospitals/facilities) and hospital administrators.
- Performs provider education through in-service activities and regularly scheduled follow up with providers.
- Effectively influences outcomes of key internal and external business issues.
- Identifies internal and external operational short-falls and researches and remediates claims.
- Executes internal business initiatives (e.g. EDI, EFT/ERA).
- Researches, collects and analyzes data on hospitals and other assigned projects.
- Designs reports to serve as a basis for decision making on hospital related issues.
- Supports effective interdepartmental communication.
- Performs other duties as assigned.
- Bachelor's Degree in Health Administration, Business or related field or equivalent work experience is required
- 2 years of experience in the managed Care industry with a focus on claims operations and best practices is required
- Previous experience working directly with customers is required
- In-depth knowledge of Medicare/Medicaid process, rules, regulations and procedures.
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Demonstrated analytical skills
- Demonstrated problem solving skills
- Ability to work as part of a team
- Ability to work independently
- Ability to represent the company with external constituents
- Customer relations business acumen
- Ability to multi-task Ability to perform a multitude of tasks simultaneously in a fast-paced customer-centered organization
- Ability to work with less structured, more complex issues
- Critical thinking skills
- Presentation skills
- Ability to support project/issue resolution
- Microsoft Word Proficient in Microsoft Office such as MS Word, MS Excel, and MS Outlook is required *LI-RG1