What are the responsibilities and job description for the Provider Relations Specialist - Full Time position at Nexus HR?
Able to work in Southern, San Bernardino, Riverside & Central California territories as needed (Company car provided)
Compensation: $32 hourly
Duties and Responsibilities:
The Provider Relations Specialist supports the Network Development department by developing and managing provider relationships and contracting efforts with providers, group practices and ancillary providers based on network adequacy and client market needs.
Compensation: $32 hourly
Duties and Responsibilities:
The Provider Relations Specialist supports the Network Development department by developing and managing provider relationships and contracting efforts with providers, group practices and ancillary providers based on network adequacy and client market needs.
- Provides service and education to Network Providers
- Liaise between the network providers and our organization, monitoring providers to ensure access standards are met
- Promote strategic initiatives and providing training for all lines of business to ensure that network providers have updated policy and procedure information
- Maintain documentation for all provider contracts via CRM
- Upload all documentation received by the provider including but not limited to W-9, Rosters, and Credentialing applications, licensure, malpractice, etc.
- Contracts and renegotiates Primary Care, Specialty Physicians and Ancillary Providers for all product lines
- Collects credentialing and required documents for newly contracted providers
- Conducts provider orientations and ongoing education to Network Providers
- Explains fee-for-service and risk contracts and provides reporting on Provider and/or Service Fund performance
- Manage provider network by developing and maintaining relationships to drive business results within a specific geographic area
- Interface daily with providers and internal constituents to effectively resolve service issues (contract inquires, claim issues, authorization request, eligibility verification) in a timely manner
- Assist in developing/managing relationships with providers
- Negotiate cost effective contracts in compliance with all state, provider, and client requirements
- Manage/negotiate contracts for non-contracted providers in established markets
- Research on provider legal name, NPI, TIN, specialty, locations, phone numbers, website, etc; affiliating all parent/child relationships as appropriate
- 30-50 provider contacts/day (Phone calls, emails, faxes)
- 5-10 Contracts/week; May vary dependent upon project
- 3-year experience in healthcare provider contracting.
- 2-year experience working with large health systems, FQHCs, RHCs.
- 2-year experience working with large multi-specialty groups.
- Must have experience working for an IPA or a Medical Group.
- Must have experience in insurance company or other payer building provider networks/contracting with physician practices, ancillary providers, facilities or hospitals.
- Able to work in Southern, San Bernardino, Riverside & Central California territories as needed (Company car provided)
- Ability to speak fluent Spanish is highly preferred.
- Dental
- Vision
- Medical
- 401k
- Paid Leave
- Others
Salary : $32
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