PROVIDER RELATIONS REPRESENTATIVE II

Job Description

We Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a ‘world-class’ candidate experience from the moment you click ‘Apply’! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Provider Relations Representative II to join our team at our office in Chesapeake, VA. The Provider Relations RepresentativeII supports and follow-through in completion of the Provider Relations function. Supports the provider relations’ team, by providing research, problem resolution and follow-up on a variety of provider issues that may arise. Target providers and facilities for inclusion in the network and maintain an appropriate and viable network in assigned areas. Provide ongoing education and assistance to providers and facilities. Coordinates activities with internal departments and external partners to optimize customer service to network providers, non-network providers, facilities and internal customers. Ensure compliance with all TRICARE and accreditation requirements for all aspects of the contracting process

What does a typical day look like?

• Monitor, facilitate and respond to all voicemails (24-48 hour call back), emails (24-48 hour same day reply), INFOrms (2 day call back), and CAPs (resolution within 30 days) within required timeframe specified for each. Respond to provider/facility questions via the telephone and email; conduct problem solving and research on issues related to claims denials, authorizations, and credentialing, re-credentialing and general provider/facility inquiries daily. All provider conversations/inquiries must be documented in SCC/CMS Database within same day of receipt.
• Must maintain up to date knowledge of ValueOptions Federal Services, Inc. ^® policies, processes, and programs. Be familiar with any contract changes that impact behavioral health. Answer providers/facilities questions regarding ValueOptions Federal Services, Inc. ^® and Military OneSource policies and procedures. Coordinate the processing and follow up of contracts, amendments, rate negotiations, and correspondence for facilities, individual providers and groups.
• Act as a liaison between providers, facilities, Military OneSource partners and other ValueOptions Federal Services, Inc. ^® departments to facilitate communication, resolve inquiries and provide education.
• Work with the Credentialing department to secure needed documents for credentialing and re-credentialing upon request.
• Maintain network adequacy and identify network needs by conducting access surveys to include recruiting additional providers and facilities, as needed, based upon routine monitoring of network adequacy, beneficiary complaints and access to care issues within assigned geographic area. Consult with Provider Relations Director to obtain prior approval when exceptional reimbursement is needed.
• Responsible for monitoring provider and facility network adequacy, recruitment, education, respond to and document all inquiries. Conduct follow-up activities for behavioral health providers and facilities within your assigned territory. Submit network analysis reports as needed or requested.
• Maintain databases and produce accurate internal reports for facilities, individual providers and groups. Ensure demographic information and facility POCs are accurate by forwarding all other demographic changes to the NetOps or directing providers to ProviderConnect.
• Monitor contract compliance on all assigned providers with goal of 100% compliance.
• Facilitate and conduct all provider/facility education to assigned network providers according to segmentation criteria. Schedule and conduct welcome call to providers no later than 30 days from effective date and provide ongoing education as needed.
• Assist the provider relations team in the areas of timely filing compliance, provider documentation quality, provider background checks, provider training, and recruitment.
• Exhibit professional verbal and written communication skills.
• Ensure the appropriate use of the chain of command.
• Maintain punctuality and regular attendance. Give proper notification when unable to meet this requirement.
• Demonstrate flexibility in adapting to new situations and demand of the job.
• Maintain a professional relationship with co-workers, PR/Credentialing Manager and Director.
• Complete research and other special projects and duties as assigned.
• Comply with all HIPAA regulations.
• Comply with established HIPAA guidelines and reports any possible violations immediately to his/her immediate supervisor and/or the designated HIPAA Officer.

What you Contribute?

Education: High School Diploma required. College degree preferred. If internal two years’ experience as Provider Relations Liaison I within the onsite Networks Department can be accepted in lieu of College degree.

Knowledge, Skills & Abilities: 3 years of experience in customer service, claims auditing or provider relations, preferably in a behavioral health and/or managed care setting, is required

Contract requires a candidate that is fluent in English and a U.S citizen

What Makes Us Different?

• Here, it’s not just a job – it’s an opportunity to change lives.
• Our employees are learners, innovators and original thinkers.
• Our mission and values guide the way we treat our members, providers and each other.

What We Have to Offer:

• Healthcare benefits available starting day 1!
• Health & wellbeing incentives, such as gym membership reimbursement
• 401K with company match to help reach your future financial goals
• Generous PTO, because we know life happens outside of work
• Tuition reimbursement so you can keep reaching your fullest potential

If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

Click below on “Apply for this Position” to create a profile and apply for the position

ValueOptions Federal Services, Inc, a Beacon Health Options company, is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from #GD

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Qualifications:

Education: High School Diploma required. College degree preferred. If internal two years' experience as Provider Relations Liaison I within the onsite Networks Department can be accepted in lieu of College degree. Knowledge, Skills & Abilities: 3 years of experience in customer service, claims auditing or provider relations, preferably in a behavioral health and/or managed care setting, is required Contract requires a candidate that is fluent in English and a U.S citizen