Provider Consultant

About the role

Serve as the primary liaison between The Healthcare Network and the participating provider community who service our members in multiple product lines throughout the network. Build and maintain 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 also includes 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 managers, 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 they pertain to the provider community.
• Identify and solve problems creatively and proficiently.
• Work independently as a telecommuter and attend off-site meetings, including overnight stays.

Essential Job Functions

• Communicate effectively as a liaison between the provider community and PBACO to educate 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 credentialing and approval, covering policies, procedures, billing, and company-wide initiatives.
• Oversee group county provider orientations by determining locations, arranging invitations, and providing PBACO provider forms, QI manuals, directories, and the PBACO Provider Office Policy and Procedure Manual as needed.
• Conduct annual Goal/Target visits with primary care and specialty care physicians within a specific geographic territory to provide continued education on policies and initiatives, scheduling at least one visit per year per practice in the following specialties: Primary Care/Specialists.

Minimum Qualifications

• 2 years of experience 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 a related field.
• 2 years of Provider Relations experience or medical office or hospital experience.
• 2 years of 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

• Extended periods of driving.
• Walking to and from provider offices, potentially up and down stairs.