Provider Relations Representative

Essential Functions

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members
• Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines
• Education providers on the Health Plan(s) functions and roles in caring for its membership
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies
• Conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s)
• Monitor, maintain and support provider relationships to insure network coverage in all areas
• Work with and be involved in implementation as needed
• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
• Complete corporate assignments as assigned

Required Skills

• Knowledge and familiarity with all levels of medical services
• Rapidly develop working relationships
• Negotiation, organization, presentation and time management skills
• Effective communication with all levels of medical staff
• Excellent computer skills, including Microsoft Office Suite
• Self-motivated, dependable, team and goal-oriented

Required Work Experience

• Experience in the health care field
• Prior experience in network development / network services
• Prior experience with acute and post-acute facilities
• Prior experience with Medicare Advantage plans

Required Education/Licenses/Certifications

• Bachelor’s degree

Other Requirements

• Available to work 8 a.m. until 5 p.m. local time
• Position requires travel to network provider locations
• Teleworking is an option if criteria are met

Equal Opportunity Employer

This employer participates in E-Verify. The Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws.