Provider Relations Representative I (Hybrid)

About the Role

This role enables a seamless provider experience by serving as a primary liaison with stakeholders within Health Services and across the company. The position provides communication, education, issue/dispute resolution, and support for managing all of CareFirst's contracted in-network providers, including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business.

Responsibilities

• Relationship Management: Establishes and maintains relationships with providers and key stakeholders through regular communications and timely problem resolution. Leverages provider relationships to drive and influence provider behavior toward favorable outcomes in support of corporate initiatives and positive member interactions.
• Training and Education: Provides ongoing and targeted training and education to the provider community, ensuring they can successfully utilize electronic tools, navigate the provider portal, and follow established processes and procedures. Partners with the Provider Training and Education Department to engage providers in the value of programs supporting positive member interactions.
• Issue Resolution: Provides research, resolution, and support for escalated service-related issues, coordinating between multiple parties across CareFirst. Identifies and resolves root causes, either independently or through formal resolution processes. Offers timely responses to providers, management, and other internal customers via virtual or face-to-face visits, correspondence, email, and/or phone as appropriate.
• Project Management: Supports network projects and outreach initiatives that require special handling by Provider Relations to mitigate risk to CareFirst, supplement existing technology, maintain critical operations, and support corporate initiatives, including provider experience scores, STAR ratings, HEDIS measures, and the CAHPS program.

Requirements

Education Level: Associate's Degree OR, in lieu of an Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.

Experience: 2 years of experience with CareFirst computer systems (or comparable technology platforms), networks, products, policies, and procedures, including experience with providers, training, customer service, and claims processing.

Preferred Qualifications

• Bachelor's Degree in business, healthcare administration, or a related industry.

Skills

• Working knowledge of provider billing and coding mechanisms, including special pricing, medical terminology, CPT coding, and CMS-1500 or CMS UB-04 claim formats.
• Knowledge of managed care industry legislated and regulated requirements, healthcare financial matters, and third-party payment methodologies.
• Previous experience working at CareFirst, an insurance plan, a hospital, or a physician hospital organization (PHO).
• Understanding of contractual documents and ability to effectively communicate terms to providers.
• Proficiency in Microsoft Excel, Microsoft Access, Microsoft PowerPoint, and Microsoft Word.
• Ability to determine priorities, meet deadlines, and manage competing priorities to comply with varying mandated deadlines.
• Self-motivation and the ability to work independently.
• Excellent written and verbal communication, including customer service skills.
• Problem-solving ability, critical thinking, and analytical skills.
• Ability to navigate, de-escalate, and resolve interpersonal conflict in client-facing roles.
• Effective presentation skills, including the ability to facilitate meetings, present information, and public speaking.
• Ability to meet established deadlines and handle multiple customer service demands from internal and external customers while maintaining service excellence.

Travel Requirements

Frequent travel (estimated at 50%) to provider offices, hospitals, and medical offices.

Pay

Salary Range: $49,464 - $98,241

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range considers factors such as scope and responsibilities of the position, candidate's work experience, education/training, internal peer equity, and market and business considerations. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on case-specific facts and circumstances, including experience, internal equity, and location.