Job Posting for PROVIDER RELATIONS REPRESENTATIVE at UHS of Delaware, Inc.
Responsibilities
Job Summary: The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within the provider network, including oversight & managing performance in various incentives based and/or value-based programs. Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with Prominence Health Plan and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem solving as necessary.
Qualifications
Job Duties/Responsibilities:
Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on topics including, but not limited to health plan operations/policies and procedures, preventative & quality outcome metrics & risk adjustment.
Responsible for understanding, developing, tracking, monitoring and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures.
Prepares for and participates in meetings with providers and provider staff and plans, creates & delivers agendas and/or presentations.
Requirements:
High School Graduate/Equivalent
Knowledge of provider reimbursement, Medicare reimbursement, coding and Hedis Measures and care gap reporting preferred.
Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan’s success
Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff
Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)
Understanding of health plan departments and functional areas for problem resolution
Experience in customer service/relations-like roles
Ability to effectively communicate in English, both verbally and in writing.
Proficient in Microsoft Office skills (Excel, Word, Access, etc.)
Enjoys working in both individual and team settings
Problem solver – enjoys problem solving
Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
Salary.com Estimation for PROVIDER RELATIONS REPRESENTATIVE in RENO, NV
$53,828 to $68,864
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