Provider Relations Representative- Health Plan

Minimum Specifications

• Education: High school diploma or equivalent
• Bachelor's Degree in healthcare related field preferred.
• Experience: 4 years of provider support, education, relationship management or contracting experience is required.
• 3 years of claims, billing, coding or revenue cycle management experience is required.
• Three (3) years of claims/billing systems maintenance and configuration is preferred.
• Additional education can substitute for experience requirements.

Skills or Special Abilities

• Advanced knowledge of health care including managed care programs that administer Medicare and/or Medicaid.
• Advanced level knowledge of provider reimbursement methodologies.
• Advanced level knowledge of network development strategies, clinical integration and accountable value based care principles.
• Expertise in gaining consensus and negotiating performance improvement plans.
• Effective knowledge of the Texas Department of Insurance, the Office of the Inspector - - - General and other state agencies involving claims and Fraud, Waste and Abuse programs.
• Functional knowledge of Current Procedural Codes (CPT), ICD-10, CMS 1500 professional claims, UB ancillary, and hospital clean claim guidelines.
• Ability to utilize personal computer applications.
• Advanced level written and oral communication skills.