Provider Relations Representative
Summary
| Title: | Provider Relations Representative |
|---|---|
| ID: | PR008 |
| Location: | Rochester |
| Job Type: | Full-time |
| Date Posted: | 06/28/2017 |
| Openings: | 1 |
| Department: | Provider Relations |
Description
GRADE: 305
POSITION SUMMARY
This position is responsible for establishing and maintaining excellent relationships with participating provider offices including health care professionals and office staff. This position is also responsible for providing support to the Department Manager, which may include, but not be limited to, training and orientation of other Provider Relations Representatives, providing input and attainment of set goals in annual departmental Business Plans, provider network adequacy analysis and interdepartmental communications.
POSITION HAS DIRECT REPORTS: No
ESSENTIAL JOB DUTIES/FUNCTIONS
OTHER FUNCTIONS AND RESPONSIBILITIES
- Support the development and maintenance of internal and external documentation and communication materials.
- Ensure accuracy of the Monroe Plan Provider Office Manual.
- Oversee updating and accuracy of provider reimbursement methodologies.
- Assist in the development and maintenance of policies and procedures for the Monroe Plan Policy and Procedure Manual.
- Assist in the development and distribution of provider bulletins and newsletters.
- Assist in the development, maintenance and distribution of Monroe Plan informational brochures.
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- High school diploma or equivalent.
- Minimum of 5 years experience in managed care, particularly in provider relations
- Knowledge of the local health care delivery systems
- Excellent verbal, written and presentation skills
- Ability to maintain thorough knowledge of Monroe Plan policies and procedures
- Personal computer skills and the ability to learn new computer applications
- Time management skills
- Willingness to travel locally and to rural counties covered by Monroe Plan operations
- Valid NYS Drivers License and work day access to an automobile
POSITION SUMMARY
This position is responsible for establishing and maintaining excellent relationships with participating provider offices including health care professionals and office staff. This position is also responsible for providing support to the Department Manager, which may include, but not be limited to, training and orientation of other Provider Relations Representatives, providing input and attainment of set goals in annual departmental Business Plans, provider network adequacy analysis and interdepartmental communications.
POSITION HAS DIRECT REPORTS: No
ESSENTIAL JOB DUTIES/FUNCTIONS
|
% of Time
|
Essential Function |
60 |
Professional Relationships with providers and office staff - Orient new providers to Monroe Plan's history, position in the community and mission. - Educate participating provider offices on Monroe Plan policies and procedures. - Proactively identify potential problem areas and work to improve processes and systems. - Assist providers in resolution of claims issues and other escalated issues. - Provide added Customer Service support to provider offices. - Conduct public relations type activities with high volume provider offices and health systems as well as provider offices in key geographic areas. - Make onsite presentations to provider offices, billing agencies and medical management companies. |
20 |
Assist in the development and expansion of the Monroe Plan comprehensive provider network. - Identify target providers for potential recruitment, particularly those in under served areas or specialties as well as in expansion counties. - Identify and implement appropriate methodologies to contact target providers and provide education on Monroe Plan participation. - Assist to facilitate the contracting process through completion for targeted providers. |
20 |
Market available services to participating providers - Identify paper submission offices and provide information on electronic submission capabilities. - Continuously market provider relations and education training and troubleshooting services. - Identify provider needs and assist in facilitating member and office education opportunities. |
OTHER FUNCTIONS AND RESPONSIBILITIES
- Support the development and maintenance of internal and external documentation and communication materials.
- Ensure accuracy of the Monroe Plan Provider Office Manual.
- Oversee updating and accuracy of provider reimbursement methodologies.
- Assist in the development and maintenance of policies and procedures for the Monroe Plan Policy and Procedure Manual.
- Assist in the development and distribution of provider bulletins and newsletters.
- Assist in the development, maintenance and distribution of Monroe Plan informational brochures.
- Participate in information management activities
- Assist in the improvement and maintenance of the Monroe Plan provider databases.
- Participate in the development of new reporting opportunities based on provider needs.
- Contribute to departmental operations by ensuring tasks and special projects are handled timely and accurately.
- Maintain active membership on community based provider interest groups, consortiums, etc. and participate in related informational presentations.
- For example – Rochester Area Patient Account Managers Association, Ask the Carriers (Monroe County Medical Society).
- Explore and lead effort of development of a Monroe Plan Office Managers Advisory Council.
- Explore and lead effort of development of a Monroe Plan Office Managers Advisory Council.
- Performs other duties as assigned.
MINIMUM REQUIREMENTS/LICENSES/CERTIFICATIONS
- High school diploma or equivalent.
- Minimum of 5 years experience in managed care, particularly in provider relations
- Knowledge of the local health care delivery systems
- Excellent verbal, written and presentation skills
- Ability to maintain thorough knowledge of Monroe Plan policies and procedures
- Personal computer skills and the ability to learn new computer applications
- Time management skills
- Willingness to travel locally and to rural counties covered by Monroe Plan operations
- Valid NYS Drivers License and work day access to an automobile
PREFERRED QUALIFICATIONS
- Associate or Bachelor’s degree preferred
- Medical claims experience helpful
- Knowledge of New York State Medicaid regulations helpful
- Medical claims experience helpful
- Knowledge of New York State Medicaid regulations helpful
This opening is closed and is no longer accepting applications
