Provider Network Advocate

Responsibilities

• Cook up provider problem resolution as identified through internal reports and by the PNL team or ISD leadership.
• Identify root causes, swiftly take the needed steps to resolve the issue and ensure closed feedback loop to the PNL and provider occurs.
• Present health plan programs and tools to network providers and their office staff.
• Follow up with provider as necessary to ensure understanding.
• Document provider outreach and initiative progress in a customer relationship database in a timely manner.
• Collaborate with other Network Leaders and staff to ensure process improvement within department.
• Manage relationships with key providers within the Health Plan provider network as directed.
• Effectively manage special projects as assigned to complete in a timely manner, occasionally extending hours beyond 40-hour work week.

Qualifications

• Bachelor's Degree in Business, Health Care, Marketing or a related field is required or equivalent experience.
• 3 years business/sales or healthcare-related experience required.
• Experience with Provider Services, Medical Claims, Customer Service, or Member Services preferred.
• Experience with claims investigation and problem analysis preferred.
• Excellent written and verbal, communication skills, as well as the ability to document organize, analyze and problem solve required.
• Ability to attend or accompany Director or PNL to various internal and external department and provider meetings.