Network Services / Provider Relations Representative
The Network Service Representative has daily interaction with internal departments as well as conversations with the Provider Network. Frequent travel to Providers’ offices is required. This position requires initiative and assertiveness when negotiation contracts or letters of agreements, as well as when dealing with provider issues and concerns. This position will write draft contracts, amendments, letters of agreement, provider correspondence and other documents as required.
This position requires knowledge of all elements of Health Choice plans processes and policies to enable education of the providers. Sound and objective decision making must be exercised in all interactions with providers and internal departments.
Initiate, coordinate, and negotiate contracts with physician providers in an assigned area to assure adequate medical services for HCU members
Provide face-to-face, written and telephone communication to providers:
Develop written materials to assist providers in following Health Choice procedures
Maintain and ensure provider demographic information is complete and up to date
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Professional Competencies (knowledge, skills, and abilities):
* Microsoft Windows applications
* Knowledge of Medicaid and Medicare programs preferred
* Knowledge of Commercial health plan programs desirable
* Ability to plan and organize
* Strong customer service skills and techniques
* Strong presentation and oral and written communication skills
* Ability to negotiate and implement contracts
* High School Diploma or GED
* College Degree preferred
* At least two (2) years customer services or claims experience with a managed healthcare plan
* A minimum of one (1) year contract analysis and contacting experience preferred