Provider Relations Field Representative

We are a fast-growing health care company with Medicare Advantage health plans in multiple states.  We have plans to grow through acquisitions and new startup operations in additional markets over the next few years.  This growth and added complexity of our operation is requiring a significant investment in human resources as well and as a result we have a new opening for a Provider Relations Representative.  In this exciting new position you will provide education, training, guidance, claims resolution and other duties as assigned for providers in the Today’s Options Health Plan.

 

JOB COMPONENTS:

§ Develop strong interpersonal relationships with providers for Today’s Options. Strengthen and enhance the role of the provider relations representative with providers.

§ Develop and maintain effective working relationship with claims department, member services department, medical management department and sales and marketing departments.

§ Recruitment of providers identifying specific providers and small provider groups in the states/counties of their area.

§ Follow up responsibilities on issues identified by providers and their offices.

§ Work with sales agents, sales manager and brokers to identify areas to recruit providers to support the new members they enroll in the plan.

§ Utilize software systems and databases to provide reports on activities to regional manager.In conjunction with regional manager develop implementation plans for  assigned areas of responsibility Assure that all responsibilities are performed consistent with the deliberate plans of the organization.Represent the organization well at all times; support its mission, goals and objectives; participate as a “team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others.  Maintain personal professional development. 

 

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements below are director of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

§ A minimum of 3 years provider relations experience in Medicare or Managed Care

§ Good knowledge of provider community in state. 

§ Knowledge of Medicare and how it is reimbursed.

§ Experience and education can be combined. Heavy provider relations background in a Medicare or commercial insurance company.  AA/AS Degree from college

§ Individual will have strong working knowledge of databases, spreadsheets, word processing and other computer software as needed.

§ Position involves excessive traveling (75%) to provider offices.  Assist in the development and maintain presentation materials for provider forums and one on one meetings with providers, hospitals, skilled nursing facilities, etc.Ability to travel 75% of the time, at times on short notice.

 

Please apply online at https://www.adpselect.com/apps/jobfit.jsp?cst=1295042.  You can cut and paste this link into your browser. 

No phone calls, email or faxes accepted.  Only individuals who apply online at  https://www.adpselect.com/apps/jobfit.jsp?cst=1295042 will be considered candidates.