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 through routine and targeted education visits regarding policies and initiatives. Responsibilities include supply deliveries and prompt follow-up on claims, benefits, and procedural guidelines for authorization of services.

Conduct on-site visits, telephonic conversations, and written communications with individuals including hospital executives, patient account managers, physicians, office and billing managers. Represent the Provider Consultant Department in workgroups and committees addressing both internal and external customer concerns regarding network operations.

Responsibilities

• Communicate effectively as a liaison between the provider community and the organization to provide education on policies and procedures and assist in resolving provider issues or concerns.
• Provider Orientations:
  • Perform on-site provider orientations for primary care and specialty care physicians regarding policies, procedures, billing, and company-wide initiatives within 30 days of credentialing and approval.
  • Oversee group county provider orientations by determining locations, arranging invitations, and providing necessary materials such as provider forms, QI manuals, directories, and policy manuals.
• Goal/Target Visits:
  • Service primary care and specialty care physicians within a specific geographic territory by conducting annual goal/target visits for continued education on policies and initiatives.
  • Schedule a minimum of one goal visit per year with participating practices in primary care and specialty fields.
• Other duties as assigned.

Requirements

• Highly proficient and creative at identifying and solving problems.
• Able to work independently as a telecommuter and attend off-site meetings, including overnight stays.
• Valid unrestricted driver’s license.

Qualifications

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

Physical Demands

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