Rep, Provider Relations I

Description

JOB TITLE: PROVIDER NETWORK CONTRACTING REPRESENTATIVE

PURPOSE:

Performs a variety of administrative functions and coordination in support of the provider contracting process and initiatives. Responsible for responding to complex and escalated contracting inquiries from a variety of network providers and partners related to Medicare Medicaid Commercial and DSNP contracts. Assists functional teams daily to ensure all requests are handled in a timely and customer focused professional manner.

ESSENTIAL FUNCTIONS:

35 Manage Contracting email boxes. Works with the appropriate leader to triage and respond to complex and escalated inquiries from external provider practices or healthcare entities as well as internal requests and bring to resolution in a timely manner or escalate to an accountable party. Follows up to ensure resolution and/or assists with tasks to support resolution.

30 Supporting and organizing contracting related workflows including but not limited to: Carrying out ad hoc mailings uploading and printing of contracts updating fee disclosures editing/updating templates gathering documentation for audits or other regulatory requirements researching returned mail and triaging complaints/inquires.

15 Update and maintain supporting documentation process and standard operating procedures for the department. Provides regular updates to management with regard to identified and outstanding issues or trends.

10 Other duties related to provider contracting and networks management as assigned.

Super Skills/Competencies

Organizational skills.

Effective writing skills.

Deadline driven.

Sense of urgency.

Proficiency with Microsoft Office 365 to include proficient and successful utilization of Word Excel Outlook and teams.

Great customer service and follow up skills.

Qualifications

Interest in understanding the healthcare industry health environment health insurance payer environment.

Understanding of Health benefits.

Preferred Qualifications

A High School Diploma or GED is required.

Experience Level

Expert Level