Provider Relations Representative (Houston)
Innovista Health Solutions, a fast-growing health care management start-up located in Westchester, IL, has an exciting opportunity for an experienced managed-care professional to fill a full-time Provider Relations Representative position in our Houston office (Sugar Land area). This position exists to help create and manage the provider network, which includes the administrative, provider education and provider resolution functions related to the provider network. This position will act as a liaison between contracted payers, providers and ancillary providers to promote superior customer service in the area of provider relations. The candidate will assist providers with questions and problems, disseminate information and provide in-service training and materials regarding policies, procedures, benefits, etc. to the providers, their administration, and staff.
The opening is a crucial position to build and manage high-performing networks and will work closely with the core operations of the organization. The ideal candidate will have strong relationship skills, be self-directed, and enjoy working with a team, while contributing his/her experience and innovative ideas.
Responsibilities:
Responsible for direct and indirect coordination of provider relations.
Perform Provider Relations functions including: education, performance reporting, provider updates and network development as assigned.
Develop strong relations with the designated providers, identifying opportunities and threats, including network composition gaps, and remediating operational short-falls.
Investigate and resolve provider complaints and member complaints regarding providers to maintain member and provider satisfaction.
Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
Be a resource for routine information, researching provider questions and communicating findings back to provider.
Assist in the development of professional, effective relationship within area hospitals, physician offices and ancillary providers.
Develop and maintain a close effective working relationship with contracted health plans, utilization management and member services departments, continually updating individual providers of operating policy and procedures.
Maintains a database of all participating physicians and ancillary providers for the areas and/or providers for which they are assigned.
Complete all provider orientations and site visits within designated timeframes.
Represent the organization well at all times; support its mission, goals and objectives; participate as a 'team player, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.
Prepare reports and attend work related after hour meetings as needed.
Create and distribute a quarterly provider newsletter.
Perform related duties as required.
Qualifications:
Associate's Degree or equivalent work experience.
Strong verbal and written communication skills.
Problem solving skills.
Requires flexibility, to be able to switch priorities in positive and effective manner when directed by network leadership.
Requires knowledge of managed care contractual terms and operational issues related to provider relation activities.
Proficient in MS Office applications: Outlook, Excel, Word, PowerPoint
Requires ability to exhibit diplomacy in resolving provider issues.
Two to three years experience in physician's office, insurance company or other health care environment.
Requires daily local travel to provider offices.
Willingness and ability to attend after hour business meetings as needed.
Must maintain valid Illinois driver's license and vehicle.
Includes:
Innovista offers a competitive salary and benefits package including medical and dental coverage as well as a generous PTO policy and incentive plan.
Opportunity for advancement and career growth
Estimated Salary: $20 to $28 per hour based on qualifications.
The opening is a crucial position to build and manage high-performing networks and will work closely with the core operations of the organization. The ideal candidate will have strong relationship skills, be self-directed, and enjoy working with a team, while contributing his/her experience and innovative ideas.
Responsibilities:
Responsible for direct and indirect coordination of provider relations.
Perform Provider Relations functions including: education, performance reporting, provider updates and network development as assigned.
Develop strong relations with the designated providers, identifying opportunities and threats, including network composition gaps, and remediating operational short-falls.
Investigate and resolve provider complaints and member complaints regarding providers to maintain member and provider satisfaction.
Proactively identify provider needs and advise management so that action can be taken to address the needs before they are problematic for the provider.
Be a resource for routine information, researching provider questions and communicating findings back to provider.
Assist in the development of professional, effective relationship within area hospitals, physician offices and ancillary providers.
Develop and maintain a close effective working relationship with contracted health plans, utilization management and member services departments, continually updating individual providers of operating policy and procedures.
Maintains a database of all participating physicians and ancillary providers for the areas and/or providers for which they are assigned.
Complete all provider orientations and site visits within designated timeframes.
Represent the organization well at all times; support its mission, goals and objectives; participate as a 'team player, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.
Prepare reports and attend work related after hour meetings as needed.
Create and distribute a quarterly provider newsletter.
Perform related duties as required.
Qualifications:
Associate's Degree or equivalent work experience.
Strong verbal and written communication skills.
Problem solving skills.
Requires flexibility, to be able to switch priorities in positive and effective manner when directed by network leadership.
Requires knowledge of managed care contractual terms and operational issues related to provider relation activities.
Proficient in MS Office applications: Outlook, Excel, Word, PowerPoint
Requires ability to exhibit diplomacy in resolving provider issues.
Two to three years experience in physician's office, insurance company or other health care environment.
Requires daily local travel to provider offices.
Willingness and ability to attend after hour business meetings as needed.
Must maintain valid Illinois driver's license and vehicle.
Includes:
Innovista offers a competitive salary and benefits package including medical and dental coverage as well as a generous PTO policy and incentive plan.
Opportunity for advancement and career growth
Estimated Salary: $20 to $28 per hour based on qualifications.
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