Description
Description:
- The Facility/Ancillary Provider Relationship Specialist I has the primary responsibility for the development of relationships between HealthNow and designated hospital PHO/IPA and/or ancillary providers.
- Provides recruitment quality service and education to these designated entities to maintain adequate provider network meeting with appropriate personnel to maintain a successful relationship resulting in substantial strategic advantage to the organization.
Primary Responsibility:
- Principally responsible for developing and maintaining effective business and contractual relationships with F/A/O (Facility/Ancillary/Other) providers.
- Expected to meet regularly with and be able to interact with various levels of provider staff including senior management.
- Assists the Director and Manager in developing improving and maintaining contractual relationships with F/A/O providers.
- Ensures Director and Manager awareness of provider activities and facilitates appropriate participation in them.
- (30%) Negotiates standard provider agreements with F/A/O providers within established budgetary and legal parameters seeking management assistance and/or approval as needed
- (20%) Serves as internal/external billing 'expert' providing claim guidance to providers and internal departments.
- Provides instruction either directly or indirectly to Claims Service and Adjustment units on complex billing issues.
- Develops and maintains thorough understanding of complex compensation methodologies and demonstrates ability to interpret and educate both internal and external customers on payment terms.
- Maintains current knowledge of Medicare and other regulatory requirements and payment methodologies.
- (15%) Monitors and analyzes contract performance including trends payment accuracy and compliance with policies and contract terms.
- Initiates corrective actions including system update requests referrals to RIU/SIU provider education and management assistance.
- (15%) Works with various departments/teams in the Company to communicate medical reimbursement and operational policies and procedures to providers ensuring our policy directives and the provider's contractual obligations are enforced and/or met while maintaining the credibility and respect of providers.
- (10%) Participates in assigned work teams committees projects etc. representing Network Services role in regards to business and systems.
- Coordinates with the remainder of the Network Services Department to develop and present provider seminars/Expos annually.
- Participates in continuous quality improvement activities with other members of Network Services staff that will contribute to improving the department's processes and supports a team concept.
- (10%) Performs other related duties as required.
Knowledge and Skills (Indicate preferred or required):
- Project management skills
- Public presentation skills
- Excellent time management skills
- Excellent organizational skills and attention to detail
- Excellent verbal and written communication skills
- Strategic thinking/planning skills
- Ability to work effectively with minor supervision
- Must be able to work in a fast-paced environment with daily work processing deadlines
- Prior experience in a fast-paced face-to-face customer service role working with daily deadlines and interruptions required
- High degree of business maturity and demonstrated confidentiality
- High energy level and ability to project enthusiasm
- Persuasive communication style
- Polished professional image and reputation
- Demonstrated customer service orientation
- Demonstrated personal accountability
- Valid drivers license and acceptable driving history required due to travel involved with this position (DMV check will be conducted to review candidate's driving record)
Education:
- Required Education:Bachelors Degree (N/A)Preferred Education:Associates Degree (N/A)
Qualifications:
- External Contacts: Providers
- Working Conditions:
- Bachelor's degree with 3-5 years of contracting experience with facility/ancillary/IPA providers.
- Associates degree with 5+ years of contracting experience with facility/ancillary/IPA providers.
Certifications:
- Bachelor's degree with 3-5 years of contracting experience with facility/ancillary/IPA providers.
- Associates degree with 5+ years of contracting experience with facility/ancillary/IPA providers.
Experience:
- Bachelor's degree with 3-5 years of contracting experience with facility/ancillary/IPA providers.
- Associates degree with 5+ years of contracting experience with facility/ancillary/IPA providers.
EEO Statement:
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
Additional Job Requirements:
- No travel required.
- Candidate must be able to work independently with direction.
- Must be extremely organized and be able to speak professionally via the telephone with providers.
- Background in provider relations a plus. this candidate will be working on a project regarding the development of a new network of providers and may need to research returned mail, therefore, experience with Internet research required as well.