Ensures meeting resources and materials are present for meeting participants, Coordinates regular provider network surveys within designated timeframes. Excellent oral and written communiation skills. Must have strong analytical abilities. EMR connectivity; E2E Contract TAT) to support comprehensive department reporting package overseen by Network Performance. office manger HCC training and lunch and learn), Assists management in developing a quarterly IPA Bulletin containing articles and announcements for the IPA network, Prepares benefit flyers for primary care physicians with health plan ID numbers, Serves as administrative support for Clinician Network Liaisons on days they are not in the office, Responds to and resolves questions or concerns from clinicians or staff in a timely and service oriented manner, Prior experience in a health plan, medical group or IPA setting working with physician networks, Identifies gaps in the provider network and opportunities for recruitment and forwards contact opportunities to filed representatives for action, Oversees and actively participates in the recruitment of new practitioners and facilities in the geographic area of responsibility including identification, calling, screening, and through attendance at trade shows, symposiums and site visits, Participates in practitioner and facility orientation and training as needed, and resolution of complaints and questions, and preventing disenrollment as necessary, Communicates regularly with network operations management to share information and ensure accurate and timely response to provider, Responsible for the oversight of Provider Relations, Network Management and Performance Improvement Departments at the Georgia Engagement Center, Manages Beacon Health Options local network development, maintenance, and contracting functions according to Beacon Health Options and state and federal regulatory requirements, procedures, applicable accreditation standards and contract requirements, Serves as the primary liaison between local, regional and centralized support functions which can include provider file maintenance, credentialing and other regional provider relations teams. This may include path-to-value and value-based contracts, Support team with maintaining HSD tables and network adequacy for Medicare/ Medicaid/ commercial, Assist to coordinate activities or projects of team; such as scheduling meetings, taking minutes, project plan updates, tracking, filing and maintaining project or task log, Associates or Bachelors Degree and/or a minimum of 5 years of provider relations experience, Demonstrated experience with process documentation, Prior experience working in the insurance industry, Prior contract interpretation experience strongly desired, Apply basic knowledge of theories, practices and procedures in a function or skill, 1+ years of experience in a network management - related role, such as contracting or provider services, In - depth knowledge of Medicare reimbursement methodologies, i.e. Provider relations is when a representative of an insurance company communicates with a health care provider. Attends health fairs and other community outreach programs when necessary, Plans valuable educational programs for the network office staff on an as needed basis, Prepares agenda, leads meetings and takes minutes for certain specialty JOC meetings, Works closely with the Director/VP to enhance physician satisfaction, Collaborates with the Director/VP on special projects and strategic initiatives, Represents HCP at community and other provider meetings, Over 1 year and up to and including 3 years of experience, Microsoft Office applications skills (Word, Excel), Serve as a key resource on complex and/or critical issues, Review work performed by others and provide recommendations for improvement, May lead functional or segment teams or projects, Provide explanations and information to others on the most complex issues, 4+ years of experience in a network management-related role, such as contracting or provider services, 3+ years of experience in claims processing, provider data maintenance, Strong knowledge of business processes related to provider experience ie contract loading, provider education, provider reimbursement, Demonstrated success in working with cross functional teams, Excellent communication and presentation skills required including ability to communicate effectively with various levels, Communication with external providers, internal stakeholders, and Health Plan CEOs, 7 years of provider relations and/or network management experience, 7 years of significant healthcare sales experience, particularly in an ambulatory setting, Extensive experience in a healthcare/clinical setting, Keen understanding of key concepts surrounding healthcare reform/transformation, Masters Degree and/or RN/Clinical Degree or certification, Intermediate level of proficiency with claims/systems processes, contracting and reimbursement methodologies, Excellent analytical and problem-solving capabilities, Requires at least 25-40% local travel to network providers, Coverage area - Philadelphia, PA and surrounding counties, Car & valid driver's license required (mileage reimbursement provided), Provides guidance on strategic plans, vision, and action plan development for the networks, Verifies and monitors IPA claims payments, Responsible for network development, including physician contracting, network relationships, network communication, physician recruitment, and network partners, Participates in network and company meetings, including physician board of directors, quality management, financial/bonus, operation, committee, Manages provider network financials, including monthly action plans, reviews, and verification, Provides guidance on strategic plans, vision, and action plan development for assigned networks, Responsible for network development, including physician contracting, rate negotiations, physician/provider network relationships, physician network communications, Participates in network and company meetings, including physician board of directors, quality management, financial, operations, etc, Responsible for maintaining compliance to CMS and company policies and guidelines, Responsible for execution of key initiatives, such as CMS Star rating program, Supervises others, including but not limited to Network Administrators and Network Operations Representatives, Minimum: Bachelors degree or equivalent experience. Start editing this Provider Relations Representative Cover Letter Sample with our Online Cover Letter Builder. Identifies agenda topics that are relevant and focuses on key issues requiring stakeholder discussion. Service Specialist provides suggestions to the provider on how it can design a new process/system so that compatibility exists with the operation. Familiarity with physicians, hospitals, clinics, laboratories, skilled nursing facilities and other institutional and individual providers, In-depth familiarity and understanding of companys internal systems and infrastructure (including claims systems, provider file systems, reimbursement systems, and member benefit systems) to effectively operationalize dental contractual provisions and requirements, Will be required to travel within a designated geographical area, Possess excellent PC skills to include but not limited to word processing, spreadsheet software such as Microsoft Word and Excel as well as presentation software development skills, Excellent and demonstrated project management, time management and organizational skills. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. role with demonstrated leadership ability or program management experience is required, Knowledge of healthcare delivery Strong functional and technical knowledge of healthcare delivery, Ability to influence internal and external constituents, On-board new physicians via in-person meetings to present the Steward Health Care Network structure, available resources, and reference materials, Set-up access to the Steward network and Steward applications for physicians and practice staff, Provide training on Steward applications on an as-needed basis to practice staff and physicians, Assistance practices with the maintenance of referral lists, Act as content expert on claims and enrollment data to support practice population health management, Coordination of Chapter leadership Board meetings including but not limited to meeting logistics, preparation and distribution of meeting materials and official meeting minutes to be filed with the regional board for approval, Coordination of Chapter POD and office manager meetings, Familiarity with Microsoft Office software (Word, Access, Excel, PowerPoint), High degree of discretion dealing with confidential information, Attends scheduled training sessions of other payers, vendors, professional associations as requested, Follows-up on issues raised at any training session, including contacting Provider Associations with updated information, and updating future training protocols and materials, Conducts state-of-the-art training sessions and seminars in locations throughout Massachusetts, including the providers office when requested and appropriate, Develops educational messages and materials for existing Providers to promote understanding of policies and procedures as well as good business practices, Create educational sessions that can be made available to providers via the customer Web Portal, Plan, develop and implement an account management strategy for assigned MassHealth Programs, Forms and utilizes interdepartmental communication workflows, protocols and relationships to coordinate all Provider support within the MassHealth Customer Service Team, A Bachelors Degree from an accredited college or university, equivalent experience considered in lieu of degree, Minimum 2 years related work experience required, Excellent organizational, communication and interpersonal skills, Understanding of common provider issues including billing practices, claim operations, enrollment and credentialing, and health care trends, Proficient in Microsoft Office (PowerPoint, Word, Excel and Outlook), Ability to perform comfortably in a fast-paced, deadline-oriented work environment, Ability to work as a team member, as well as independently, Resolve operational issues that are routed to the Provider Relations team either telephonically or via e-mail, Review and approve expense reports submitted by the HouseCalls Providers, Assist with the creation and completion of travel requests for HouseCalls Practitioners, Assisting with outbound calls to ensure practitioners have loaded required hours of availability, Provide assistance to HouseCalls Practitioner field by quickly and efficiently addressing practitioner concerns, Assist with the composition and review of production based reporting for HouseCalls regions, 1 + year of MS Excel - basic formulas, analyzing data, filtering and sorting, Any experience with Workforce Management or Operational Support, Primary Phone Coverage for the Provider Relations Escalation Hotline, Answering occasional e-mails, and Pulse tasks coming into the department from Pharmacies and internal departments, Supporting pharmacies and internal Catamaran departments with pricing, reimbursement, and claims processing inquiries, Developing and maintaining a positive relationship with contracted pharmacies, and coordinating effectively with internal and external partners to ensure pharmacy inquiries are handled and resolved in an accurate and timely fashion, Utilizing the Provider Relations Tracking Database and log all calls coming in, 1+ year experience the pharmacy benefits management (PBM) business, Intermediate level with Microsoft Word, Excel, and Access, Ability to travel regionally about 5% of the time, Proficiency with MS PowerPoint and Access, Knowledge of Medicare and Medicaid regulations, Experience with medical coding, or medical coding certification, Analyzes current network and projected network needs from cost/utilization, competitor and member access standpoints and develops and implements contracting activities as indicated, Participates in contract mailing preparation, makes and receives provider calls, time manages daily work activities to meet longer-term project goals and timelines, Keeps detailed and accurate notes regarding all negotiation efforts in the Tracking database, Prepares instructions for fee schedule and contracting loading that accurately reflect contract language, rates and intent, Works cross-functionally with other departments to remove barriers impeding contract negotiations, manage contract implementation, identify opportunities for process improvement and facilitate problem resolution, Performs other responsibilities as assigned for special projects and escalated issues, Two years experience in a contracting/negotiation setting, provider contracting preferred, or health care/medical office environment, Experience in conducting data analysis and creating reports in Excel, OR, any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position, Solid understanding of health plan products/lines of business, familiar with basic medical contracting methodologies and claims pricing/reimbursement strategies.
Client Relationship Manager Cover Letter Examples - Kickresume Identifies areas to improve provider service levels, Performs strategic planning for membership growth, retention, and to affect sophisticated or complex provider relationships, Provides training, mentoring and guidance to new managers, Advanced Knowledge of healthcare delivery Strong functional and technical knowledge of healthcare delivery, Advanced Ability to effectively present information and respond to questions from peers and management Presentation skills to communicate business plans in an effective manner, Responds to various inquiries from participating physicians, network staff, hospital staff, and managed care companies, Resolves issues related to credentialing, managed care participation, claims payment, demographic changes, referrals and accessibility, Responds to physician requests, provides updates and resolves issues, Coordinates and implements credentialing activities to assist providers with the completion of applications for network contract offerings; monitors applications and follows-up as needed, Conducts provider and facility credentialing and re-credentialing activities, Communicates with providers to obtain requisite credentialing information to facilitate timely completion and submission of required documents, Facilitates re-credentialing requests and coordinates site visits related to managed care contracts, Prepares and reviews physician membership applications, verifies credentialing materials and enters into database, Communicates with providers regarding Network provider enrollment policies, procedures and contractual obligations, Maintains provider files, as well as availability and contract specific sentinel events, Assist with coordination, education and outreach. Outstanding customer service skills, Ensure providers have in depth understanding of MSLA model of care to include, but not limited to, contractual obligations, Participates in provider service expansion to assure network adequacy as needed, Minimum 2 years of experience performing customer service in a healthcare setting, Maintains close communications with officers of the Piedmont Clinic, CEO/CMO pf the Piedmont Clinic, Executive Director of the Piedmont Clinic, Medical Director of Piedmont Hospital, and Director of Quality Management Department for Piedmont Hospital; keeps the Administration, Medical Director, Executive Director, and physician membership appraised of problems concerning their areas, Maintains records on all physicians, confidential files, bylaws, amendments, and rosters, Updates all databases containing physician information on a daily basis and provides reports as requested for the CEO/CMO, Executive Director, or Piedmont Hospital Medical Director, Responsible for physician mailings and general correspondence, Coordinates and supervises Quality Specialists/Provider Relations staff duties; organizes, implements, and maintains procedures for recording and filing various administrative forms, reports, and confidential medical information, Receives, screens, and assists telephone callers, referring calls to Executive Director or Medical Director when appropriate, Handles special assignments, reports with minimal guidance, Maintains strict confidentiality on all physician and practice matters, Attends required meetings, coordinates and attends in-services and participates in committees as required, Knowledge of emerging healthcare trends to be able to inform and execute growth strategy, Intellectual inquisitiveness with a desire to create practical/innovative solutions, Ability to cultivate new opportunities by initiating a plan to increase operating margin, Ability to research, understand and explain healthcare services' volume, utilization, market data, and physician referral patterns, Coordinates the management and growth of the hospital relations program or ancillary networks; monitors and resolves hospital or ancillary network concerns and issues, Manages advocacy/education process with hospitals and ancillary networks, Develops and implements processes that ensure hospitals and ancillary providers claims are paid accurately, timely, and on first submission, Monitors team activities to assure that staff meets performance standards and is operating effectively and efficiently; resolves escalated claims/operations issues, Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment plans, Manages the provider complaint and Provider Relations databases; develops and implements action plans regarding provider satisfaction results, Hires, trains, coaches, counsels, and evaluates performance of direct reports, Holds team accountable for provider satisfaction, 25% field travel (provider visits with team members, attend conferences, etc. Providers are anyone who professionally performs health care services and include physicians, dentists and nurse practitioners. This way, you can position yourself in the best way to get hired. Augments knowledge with reference materials as needed, Provides response and takes appropriate action to resolve. Lead staff in developing and maintaining positive operational relationships with the broad network of providers. Manager, Provider Relations and Supervisors as requested, Minimum of three (3) years of professional experience in a healthcare organization required, but preferred in managed care, Minimum of two (2) years of clerical/customer service position with excellent interpersonal-relations skills, and command of the English language required, At least one (1) year of active experience with use of Microsoft Office suite, Internet Services, and Access required, Prior experience Provider Relations experience highly preferred, Additional education and data systems training are preferred, Establishes a routine communication cadence with key providers in order to communicate initiatives and outcomes, Ensures effective problem resolution, and facilitates communications between providers and payor partners, Provides recommendations for innovative projects and processes to help improve deliverables and/or existing processes, Bachelor's degree in business or related field preferred, Minimum of three years of experience in healthcare operations, provider relations, or a business setting, Health plan, health system, or provider group experience preferred, In collaboration with division and/or market clinical and business development leaders, evaluate, analyze, and interpret market utilization data for market facilities' service line, ensuring that sales priorities are identified in line with the vision and strategic goals of the Behavioral Health service line, Evaluate, analyze, and interpret market demographics, including population, age, gender, race, and projected trends for both physicians and patient populations, In collaboration with division and/or market CEO's, evaluate, analyze, and interpret current physician and key non-physician referral patterns and trends for market facilities' service line, ensuring that sales resources are optimized, Selling of service line attributes, processes, and outcomes to consumer, physician, and market facility groups/individuals, In collaboration with division and/or market physician services, facility leaders, medical staff leadership and facility physician development teams develop sales and retention strategies for target markets and facility Behavioral Health services, Develop goals and timelines for closing new or enhanced physician and key non-physician referrals, Execute sales and retention strategies and plans; successfully close new business in accordance with predetermined targets, Complete face-to-face sales meetings with physicians and practice managers, and key non-physician referral sources ensuring that a thorough understanding is gained regarding the physicians'/referral sources' desires and needs, Complete follow-up meetings with physicians, practice managers, and/or other key referral sources as needed to close new or additional business, ensuring that internal and external obstacles to business growth and retention are identified and minimized or eliminated, Prepare and present monthly sales reports, identifying trends, additional business opportunities, and obstacles to retention and new business growth, Continuously modify sales and retention strategies and plans to ensure optimal business outcomes and "win-win" results for physicians, key non-physician referral sources and company market providers for the service line, Attend service line specific medical staff meetings, Ability to access, understand, and explain physician and key non-physician referral patterns, Ability to plan, organize and manage resources within prescribed timeframes (prioritize and focus), Ability to identify and respond appropriately to primary client/customer needs (service orientation), Ability to demonstrate effective listening and communication skills, Ability to provide follow-up and demonstrate attention to detail, Ability to prepare and present executive reports, Ability to actively listen to physician and key non-physician referral source practice needs for hospital inpatient and outpatient services, Provider Relations and quality compliance oversight, Oversight of Provider Relations Representatives Specialists, Coordinate monthly LTSS Provider Review Committee meetings to review provider quality of care issues and recommend actions for enrollment, credentialing and revalidation findings, Summarize committee findings in a monthly LTSS Provider Review Committee report and an annual Provider Review Summary Report, Training of internal staff and external LTSS Providers, Review monthly quality reporting - Call Center, turnaround times, enrollment activities, credentialing/revalidation activities and coordinates reporting to EOHHS, Work with Quality Improvement Committee to develop and implement appropriate corrective action plans, Use risk management and patient safety data to identify and implement quality improvement, for example, prompt identification and handling of member abuse, neglect, and/or exploitation, Provide coverage for RN Utilization Management Lead and Appeals Coordinator, Minimum of 5 years clinical nursing experience inclusive of Provider Relations and Quality Improvement experience, 3 years in a management / supervisory role in in a managed care environment, Effective communication skills, flexibility and displays positive attitude, Builds relationships with providers and establishes effective communication methods between the providers, management and internal staff, Recruits and outreaches to potential providers, Assists current providers in expanding their existing services and/or areas of service, Conducts initial and on-going site visits and quality audits for credentialing/re-credentialing purposes, Orientation and training of new providers to ensure understanding of Amerigroups expectations and of the CHOICES/ECF programs and/or services, Provider Advocacy and Issues Resolution (billing/claims etc.
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