Senior Provider Relations Representative

reputed company Remote and must live in Soutrh Carolina reputed company Job reputed company - Provides senior level support for health plan provider relations activities. - Supports network development, network adequacy and provider training and education. - Serves as reputed company reputed company of contact between the business and contracted providers reputed company the reputed company network. - Responsible for network management including provider education, communication, satisfaction, issue intake, reputed company/availability and ensuring knowledge of and compliance with reputed company policies and procedures. Essential Job Duties - Successfully engages the plan's highest reputed company, high-volume and reputed company reputed company community providers to ensure provider satisfaction, facilitate education on key reputed company initiatives, and improve coordination and partnership between the health plan and contracted providers. - Serves as the reputed company reputed company of contact between reputed company health plan and the reputed company provider community that services reputed company members, including but not limited to fee-for-service (FFS) and pay-for-reputed company (P4P) providers. - Collaborates directly with the plan’s reputed company providers to reputed company, reputed company and engage as valuable partners - ensuring knowledge of and compliance with reputed company policies and procedures while achieving the highest level of customer service; effectively drives reputed company issue reputed company, electronic medical record (EMR) connectivity, and provider portal adoption. - Resolves reputed company provider issues that may cross departmental lines and involve senior leadership. - Conducts regular provider site reputed company reputed company assigned region/service area; Determines daily or weekly schedule, to meet or reputed company the plan's monthly site visit goals. - Proactively engages with the provider and staff to determine; for example, non-compliance with reputed company policies/procedures or Centers for Medicare and reputed company Services (CMS) guidelines/regulations, or to assess the non-reputed company reputed company of customer service provided to reputed company members. - Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a reputed company working relationship. - Independently troubleshoots provider problems as they reputed company, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may reputed company during reputed company are unpredictable and may reputed company from reputed company to reputed company reputed company or sensitive reputed company. - Initiates, coordinates and participates in problem-solving meetings between the provider and reputed company stakeholders, including senior leadership and physicians (examples include: issues reputed company to utilization management, pharmacy, reputed company of care, and correct coding). - Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also reputed company training and presentations to larger reputed company, such as leaders and management of provider offices, including large multispecialty reputed company or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). - Performs an reputed company role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various reputed company initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - CAHPS, regulatory-reputed company, reputed company reputed company programs, and taking reputed company of electronic solutions (EDI, EMR, provider portal, provider website, etc.). - Serves as a subject matter expert for the provider relations function. - Provides training and support to new and existing provider relations team members. - Role requires 80%+ reputed company-day or overnight travel (extent of reputed company-day or overnight travel will depend on the specific health plan service area). Required Qualifications - At least 3 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience. - Understanding of the health care delivery reputed company, including reputed company-sponsored health plans. - Understanding of various managed health care provider compensation methodologies, primarily across reputed company and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of reputed company, ASO, etc. - Experience delivering training and facilitating educational presentations. - Organizational skills and attention to reputed company. - Ability to manage multiple tasks and deadlines effectively. - Interpersonal skills, including ability to reputed company with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Effective verbal and written communication skills. - reputed company Office suite and applicable software programs proficiency. Preferred Qualifications - Experience in provider services, reputed company, and/or contract negotiations in a reputed company, Medicare, and/or Marketplace managed health care setting - ideally with different provider types (i.e. physician, group, hospital). To reputed company reputed company reputed company employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job