Provider Relations Representative (52758)

Summary

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer focused on providing personalized, responsive services and affordable health insurance coverage. The Provider Relations Representative maintains provider data integrity, supports provider inquiries and onboarding, develops provider networks, and helps ensure compliance with CMS and NCQA standards.

Responsibilities

• Assists in maintaining accurate Provider/Vendor records and Provider Directory
• Develop and evaluate the provider network to ensure appropriate access and availability for Health Plan membership
• Create and verify Provider Data integrity with on-going monitoring and responds to daily inquiries in a timely manner
• Educate and assist providers to maximize data integrity and provider experience
• Cultivates and maintains collaborative internal and external relationships to maintain and improve positive interpersonal relations and execute network strategies
• Responds timely to provider nominations by providing guidance and insight to leadership based on network need
• Actively participates and assists in meeting CMS guidelines and NCQA accreditation standards
• Assists in the on-boarding of new providers. This may include training and education to providers to ensure success in the program
• Resolves Provider Inquiries via Provider Relations email, CRMs, Joint Operating Committees and surveys in a timely manner
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy
• Performs other duties as assigned

Skills

• High school diploma or equivalent is required
• At least two years of related experience with a payer or provider organization with responsibility for provider relations, provider credentialing, and/or provider information management required
• Computer Proficiency Demonstrated proficiency in the use of personal computer applications; specific skills to include Microsoft Word, Outlook, Excel v-lookup, and ability to build and compare files using NPPES data and provider taxonomy
• Interpersonal Skills Ability to quickly develop rapport and work effectively and professionally with all levels of personnel
• Problem-Solving Skills Ability to investigate/research problems and issues and to recommend associated corrective actions
• Discretion Ability to manage sensitive or confidential information in a professional and discreet manner
• Must have access to a reliable and secured internet connection source
• None
• Bachelors degree preferred

Qualifications

Must Haves

• High school diploma or equivalent is required
• At least two years of related experience with a payer or provider organization with responsibility for provider relations, provider credentialing, and/or provider information management required
• Computer Proficiency Demonstrated proficiency in the use of personal computer applications; specific skills to include Microsoft Word, Outlook, Excel v-lookup, and ability to build and compare files using NPPES data and provider taxonomy
• Interpersonal Skills Ability to quickly develop rapport and work effectively and professionally with all levels of personnel
• Problem-Solving Skills Ability to investigate/research problems and issues and to recommend associated corrective actions
• Discretion Ability to manage sensitive or confidential information in a professional and discreet manner
• Must have access to a reliable and secured internet connection source
• None

Nice to Haves

• Bachelors degree preferred

Benefits

• Current work environment is remote, however, some state exclusions apply.