External Provider Relations Representative

External Provider Relations Representative



We are seeking an experienced External Provider Relations Representative for our Network Operations Department in Birmingham, AL.

 

 

SUMMARY: Involving extensive interaction with physicians, physician offices and health plans, this position will provide a broad overview of managed care and the many aspects involved in effective management (financial understanding, network building, conflict/issue resolution, etc.).  Position requires that the majority of time be spent externally.

 



RESPONSIBILITIES AND FUNCTIONS:

 

Support in the Management of Multiple Networks:

· Meeting Preparation

· Board Meetings

· Preparation of Agendas/Minutes

· Ability to Lead/Conduct Meeting; Complete Understanding of Issues Presented

· Attendance of all Meetings

· Preparation of Follow-up Items from Board Meeting

· Financial Review Meetings

· Assist Administrators in Preparation of Action Plans

· Coordination of Reports/Information to be Presented

· Identification of Trends

· Understanding of Information and Ability to Field Questions

· UM/QM or Other Committee Meetings

· Preparation of Agendas/Minutes

· Attendance of Meetings

· Team Meetings

· Scheduling/Coordination of Meetings

· Preparation of Discussion Items

· Office Orientations/Re-Orientations

· Provide Education on Ongoing Issues

· Insure Contracted Offices have Necessary Information (forms, guidelines, etc.)

· Determining, Communication and/or Resolution of Office Staff Concerns

· Educate/Update Offices on Provider Manual Policies & Procedures

· Claims/Encounter Data Oversight

· Monitor Weekly Encounter Data and Identify Trends/Issues

· Coordination with Claims Department 

· Monthly Capitation Distribution

· Verify/Distribute Monthly Cap Checks and Relevant Information

· Preparation/Distribution of Rosters, Matrices, etc.

· Coordination with Business Support/Finance

· Contracting

· Assist Administrator with Physician Contracting and Rate Negotiation

· Coordinate with Credentialing/Business Support to Insure Processes are Followed

· True-up/Bonus Distributions

· Prepare/Distribute all Information

· Lead/Conduct Meetings; Complete Understanding of Information Presented; Ability to Field Questions from Providers

· Coordinate with Finance/Business Support to Insure all Information is Correct and Timelines are met.

 

REQUIREMENTS:

 

Education:College degree preferred.

 

Experience:Managed care experience preferred (2 years) or 4 years work experience in office environment

 

 

 

HealthSpring offers a competitive salary and a full range of benefits.

 

Go to www.healthspringofalabama.com & complete an online application.

 

Select Department:  Provider Relations

Select Position: External PR Rep

 

 

Attach resume. Include salary history/requirement. No phone calls accepted.

HealthSpring, Inc. is an EEO/AA employer.