Provider Relations Specialist III

About the role

The Provider Relations Specialist III is a professional, outward-facing representative responsible for the development and management of positive business relationships with Tier 1 and other external network (contracted) providers. This is accomplished by daily interactions (phone/virtual) and a combination of strategically planned virtual and occasional in-person meetings (regularly cadenced and ad hoc).

Responsibilities

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives.
• Supports continuous improvement efforts by organizing provider, claims, and contracting data to assist the team in identifying and/or consulting on continuous improvement opportunities across the contract ecosystem.
• Ensures contract commitments are met by organizing provider data in appropriate data platforms and supporting the consultation of provider compliance; documenting provider activities and/or supporting the collaboration with alternate stakeholders to ensure compliance with contract terms and conditions.
• Supports contract strategy development by executing tasks to support strategies that improve access to patient care while managing outside service costs, with minimal supervision; collaborating with team members to provide consultation on local service delivery planning to aid in the achievement of provider priorities and strategies.
• Serves as a liaison between providers and KP by completing communication tasks independently (e.g., contract compliance such as access, availability, referral operations, and/or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by organizing components of itineraries and agendas, gathering credentialing materials, and/or supporting the initiation of this process.
• Contributes to provider satisfaction by using comprehensive foundational knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, other operational issues, and/or directories.

Requirements

• High School Diploma or GED AND five (5) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.
• One (1) year of experience working with Microsoft Excel, including working with formulas and developing integrated workbooks.
• Two (2) years of experience with industry standard claims coding and submission processes.

Qualifications

• Navigating the Hiring Process

Skills

• Business Knowledge
• Communication
• Critical Thinking
• Decision Making
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Learning Agility
• Organizational Savvy
• Problem Solving
• Quality Assurance Process
• Trend Analysis
• Topic-Specific Communication
• Workforce Development

Benefits

• Flexible schedule
• Full-time employment
• Day shift

Pay

Competitive salary commensurate with experience.

Schedule

Flexible schedule.