Senior Provider Relations Account Specialist

California  ‐ Onsite
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Description

Summary
  • Senior Provider Relations Account Specialist is responsible creating, implementing and evaluating training programs for Provider Relations Staff, as well as training needs for internal departments with the roll-out of new programs from Provider Network Operations.
  • Monitoring or provider performance including but not limited to overseeing accurate and current provider databases, provider training, education and information to providers and responding to all provider related inquiries
  • Duties also include Facility Site Review (FSR) management to ensure Provider offices are prepared for site audit.
  • Responsible for creating, implementing and evaluating training of Provider Relations staff.
  • Assist with policy and procedure interpretation, research, analyze and resolve complex problems dealing with claims, appeals, grievances and eligibility
  • Functions as a lead among other department staff.
  • Acts as a resource in resolution of very complex or escalated issues.
  • Supports and/or participates in provider contract negotiations.
  • Represents Manager, Provider Relations when Manager is not available.
  • Creates and maintains a positive working relationship with all contracted Providers as assigned
  • Providers will include Participating Physician Groups (PPG's), Hospitals, Ancillary, Specialty Health Plans, Sub-Contracted Health Plans and Long Term Care Providers
SKILLS:

Qualifications
  • Working knowledge of the compliance/regulatory requirements of DMHC, DHCA, CMS, NCQA, HEDIS, HIPAA, etc
  • Experience in managed health care environment with exposure to provider contracting, servicing, benefits interpretation and internal operations of provider relations functions required
  • Education: Bachelors Degree in Health Services, Health Care/Hospital Administration, a related field or any combination of education and/or equivalent
  • Minimum 8 years progressive provider services/relations experience with a health plan or medical group
  • 3 years creating training programs and training staff
  • Excellent oral and written communication skills and presentation skills
  • Strong analytical and problem solving skills
  • Demonstrated ability to deliver training and conduct meetings to varied audiences
  • Experience with Microsoft office applications
Start date
n.a
From
Synectics
Published at
06.05.2016
Project ID:
1124183
Contract type
Freelance
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