Provider Network Representative

Overview

Required skills & experience (the “must haves” to be considered) • Working knowledge of Health Plan policies and procedures, including contracting, credentialing, billing/payment, incentive programs, and utilization management preferred. • Proficient in MS Office, CRM Systems (Salesforce Preferred). Knowledge of WebEx and/or GoToWebinar strongly desired • Detail oriented with strong organizational skills. • Must be able to work independently in a fast-paced environment. • Ability to manage in a geographically dispersed, complex and changing environment. • Ability to work directly with diverse individuals, both internally and externally. • Must have an active driver’s license. What you need to know • Bachelor’s Degree in Business Administration, Healthcare Administration, related field, or equivalent experience (1-2 years preferred). • Strong communication (verbal and written), interpersonal, customer service understanding and ability to triage and resolve provider issues efficiently and effectively. • Local candidates only Job Description The Provider Network Representative (PNR) assists in Provider Relations with all current lines of business. PNR will support daily Provider Relations activities including direct phone contact (both inbound and outbound) for questions, support, and issues resolution with Provider entities. PNR will routinely interact with Provider entities and be the first point of contact for Providers contacting the Network department. • Function as the primary point of contact for all inbound calls or emails received from Providers or internal departments. • Triages all inbound issues appropriately after attempting to resolve Provider needs on first touch. • Documents, tracks and reports provider data within assigned scope of responsibility. • Provides outbound phone contact with Providers, as directed and as needed. • Maintains and updates Provider Database timely and accurately. • Respond to provider inquiries and educate Providers on operations updates. • Work closely with Network Managers, Network Contractors, Credentialing and departmental leadership to ensure providers receive necessary documentation, as needed or as requested by providers. • Coordinates with Network Development, claims, intake, staffing, and other departments to triage and/or resolve Provider issues. • Communicate any operational or administrative challenges, providing constructive feedback for service improvements and develop corrective action plans. • Assist Network department with provider communication planning and distribution, such as email blasts or other mass communications, as directed. • Assists with development of Provider education materials. • Support and attend meetings and conference calls as indicated. • Demonstrates high level customer service skills. • Accepts additional assignments willingly.

Benefits

Company

A technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs.