Provider Relations Specialist

Are you an experienced Provider Relations Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "YES" to any of these questions - this is the position for you!

Daily Responsibilities and Details:

• Assure that all provider orientations, site visits, access and availability studies are completed within designated timeframes; assure that all providers are visited within established timeframes.
• Facilitate retrieval of Fidelis Care New York’s member healthcare records to ensure achievement of optimum QARR scores.
• Investigate and resolve member complaints regarding providers to maintain member and provider satisfaction; clarify the provider's problem; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction or adjustment; follow up to ensure resolution.
• Assist Contract Management in identification of network deficiencies and make recommendations on how to address them.
• Establish and foster strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and identifying onsite enrollment opportunities for Marketing.
• Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
• Educate providers on the Plan’s provider incentive programs.
• Educate providers on all billing requirements related to initial claims and corrected claims. Educate providers on the processes related to obtaining prior authorizations for services
• Responsible for internal and external provider communications of program updates and changes to programs, including the provider manual and tip sheets
• Identify and resolve provider billing problems related to authorizations and claims. Provide appropriate provider education and re-education.
• Perform work related to servicing and managing the Fidelis Care network of participating
• Identify trends related to claim denials and coordinate appropriate internal and external follow up.
• Provide ongoing education to quickly resolve issues
• Pay: 24.00/hr
• Shift: Mondays to Fridays, 8:30 am to 5:00 pm
• Length of Assignment: Contract to perm
• Start Date: ASAP
• Location: IN-OFFICE at: 5010 Campuswood Drive, East Syracuse NY 13057

Requirements:

• Fully vaccinated
• HS Diploma or GED
• 5 to 8 years of healthcare, claims, or provider related experience required
• 3-5 years’ experience working in a managed care environment serving in Provider relations, Contract Management, or equivalent role
• Knowledge of various provider payment methodologies
• Strong verbal and written communication skills

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment

Why You Should Work for Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Refer potential candidates! We provide a bonus to referrals who get placed and sits in a job for at least 45 days! Use this referral link: https://sensereferrals.com/healthcare-support/r/2732117

Ethan Tapales

P: 407 792-0689

E: etapales@healthcaresupport.com

Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.