Provider Consultant

About the role

This position serves as the primary liaison between The Healthcare Network and the participating provider community who service our members in multiple product lines throughout the network. The role builds and maintains strong relationships with providers by offering excellent customer service to assigned primary care and specialty care physicians, including routine and targeted education visits to keep them informed about policies and initiatives. Service responsibilities include supply deliveries and prompt follow-up regarding claims, benefits, and procedural guidelines for authorization of services.

Responsibilities

• Conduct on-site visits, telephonic conversations, and written communications with hospital executives, patient account managers, physicians, office and billing managers.
• Perform on-site provider orientations and group county orientations for new primary care and specialty care physicians regarding policies, procedures, billing, and company-wide initiatives.
• Represent the Provider Consultant Department in workgroups and committees addressing internal and external customer concerns related to the operations of The Healthcare Network as it pertains to the provider community.
• Communicate effectively as a liaison between the provider community and PBACO to provide education on policies and procedures and assist in resolving provider issues or concerns.
• Perform on-site provider orientations for primary care and specialty care physicians within 30 days of becoming credentialed and approved.
• Oversee group county provider orientations by determining location, arranging for mailing of invitations, and making available PBACO provider forms, QI Manuals, directories, and the PBACO Provider Office Policy and Procedure Manual.
• Conduct annual Goal/Target visits with primary care and specialty care physicians within a specific geographic territory to provide continued education regarding policies and initiatives.
• Schedule minimally one goal visit per year with participating practices in the following specialties: Primary Care / Specialists.

Minimum Qualifications

• 2 years’ experience required in Provider Relations and/or Managed Care Product Administration.
• Valid unrestricted driver’s license.

Preferred Qualifications

• Bachelor’s degree in Business Administration, Marketing, Health Care Administration, or other related degree.
• 2 years’ Provider Relations experience or medical office or hospital experience.
• 2 years’ exposure to medical claims processing procedures.
• Knowledge and understanding of the dynamics of the Managed Care environment, including capitation and reimbursement structure.

Physical Demands/Requirements

• The position requires driving for extended periods of time, as well as walking to and from provider offices potentially up and down stairs.