Provider Servicing Specialist – Region 9

Position Summary

Position to cover servicing for Podiatry, Dermatology and Orthopedic Network in Region 9.

Manages the Podiatry, Dermatology and Orthopedic Physician networks by developing and maintaining relationships to drive business results within a specific geographic area.  Provides service and education to Network Providers and staff.  Achieves company targets through implementation of the policies and procedures.

Duties and Responsibilities

  • Completes new provider orientation within thirty (30) days of health plan effective date for all applicable health plan partners’ product lines.
  • Conducts monthly site visits to resolve issues, educate new staff/providers on policies, collect new/updated credentialing information and review any changes/updates to the Provider Manual or Network guidelines.
  • During initial onboarding, meets with the appropriate Network Provider personnel and fully explains the company’s protocols, including but not limited to, all requirements necessary to comply with standards identified in the Provider Manual.
  • Achieves quarterly servicing goals to establish consistent and strong relationships with Network Provider offices.
  • Provides oversight and education to Network Providers on inquiries and claims issues and follows-up with Network Provider and Provider Servicing Coordinator to ensure issues have been resolved.
  • As applicable, will forward identified network gaps to the Contracting Manager to fill the deficiencies.
  • Liaison, in conjunction with Provider Servicing Coordinator, to all health plans.
  • Understands and explains network physician contracts, if needed.
  • Strategizes for network provider and health plan retention.
  • Special projects as assigned or directed.
  • Exercises discretion and independent judgment in matters involving the servicing of providers.

Knowledge

  • A Bachelor’s Degree in a related field or equivalent related Network Development or Provider Relations experience.
  • Minimum three (3) years’ experience in Medicaid/Medicare is preferred.
  • Healthcare, provider office or HMO/PPO background preferred.
  • Strong knowledge of regulatory requirements concerning Medicare and Medicaid preferred.

Skills

  • Excellent problem solving skills.
  • Excellent oral and written communication skills.
  • Bilingual language skills a plus.
  • Intermediate or stronger skill level with MS Word, Excel, Outlook and PowerPoint.

Abilities

  • Must be organized and have excellent time management capabilities.
  • Ability to analyze data to identify trends and variance from goals.

Physical Demands

The physical demands described here are representative of those that must be met by the employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; reach with hands and arms and talk and hear.  The employee is occasionally required to stand; walk and stoop, kneel or crouch.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Position Type/ Expected Hours of Work

This is a full time position.   Days and hours of work are Monday through Friday general time span: 8:00 a.m. to 5:00 p.m. Occasional evening and weekend work may be required as job duties demand.

Work Environment

This job operates in a clerical office setting.  This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.  The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel

Yes, 80 % of the time or as otherwise required by the company.

Other Duties

Please note this job description is not designated to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.

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