Manages the relationship and all levels of operations support with network hospitals. Provides ongoing education to facilities regarding health plan operations. Identifies and implements process improvements and enhancements.
DEPARTMENT: Provider Relations
REPORTS TO: Manager, Provider Relations
- 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.
- Required a Bachelor's Degree in Health Administration, Business or related field
- Required 2 years of experience in the managed care industry with a focus on claims operations and best practices
- Required previous experience working directly with customers
- Required in-depth knowledge of Medicare/Medicaid process, rules, regulations and procedures.
- Advanced demonstrated interpersonal/verbal communication skills
- Advanced demonstrated written communication skills
- Advanced demonstrated analytical skills
- Advanced demonstrated problem solving skills
- Intermediate ability to work as part of a team
- Intermediate ability to work independently
- Advanced ability to represent the company with external constituents Customer relations business acumen
- Intermediate ability to multi-task Ability to perform a multitude of tasks simultaneously in a fast-paced customer-centered organization
- Intermediate ability to work with less structured, more complex issues
- Advanced critical thinking skills
- Intermediate presentation skills
- Intermediate ability to support project/issue resolution
- Required intermediate Microsoft Word
- Required intermediate Microsoft Excel
- Required intermediate Microsoft Outlook