Job Description

Our Mission:  Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.

Our Vision: 

Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.

Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!

Position Purpose:  The Provider Performance Representative position requires managing a geographic territory of assigned providers, to include scheduling and making frequent visits to provider offices, assisting with provider issues & concerns, all while having strong initiative and excellent customer service focus.  The documentation of visits is a requirement for this position as well, so there is an accurate reflection of provider issues & concerns.   This position will generate provider correspondence as needed, as well as having a base knowledge of the internal claims & tracking systems, all elements of Health Choice processes & policies, in addition to AHCCCS, CMS, and HealthCare Exchange plans to enable education of providers.  Sound and objective decision making must be exercised in all interactions with providers & internal departments, with excellent verbal and written communication skills.

Responsibilities:

  • Meet with providers to review operational procedures as they relate to Health Choice, to include, but not limited to, issues surrounding or involving prior authorization, claims/revenue cycle concerns, provider roster/location updates and contracting.  Provide in-service/education to providers in these areas.
  • Use the site visit checklist to ensure that all discussion topics are covered.
  • Review provider performance in areas such as claims turn-around times, denials & reject reports. 
  • On an annual basis, ensure all providers review & attest for the Health Choice MOC training.
  • Obtain & review provider rosters to ensure demographics & fee schedules are up-to-date & correct, at least bi-annually.
  • Work with the Resolution Center to ensure our provider database is updated & accurate.
  • Ensure that current provider demographic changes & additions are submitted & completed within SLAs.
  • Plan visits at least two (2) weeks in advance, and collaborate with management as needed.
  • Interact with Claims regarding payment schedules and rates of reimbursement.
  • Inform providers of policy changes and/or new policies.
  • Assist with development & distribution of Provider Manual and ensure providers are familiar with it, and know how & where to find it.
  • Assist with the provider newsletter and participate in Provider Forums.

Education / Experience / Other Requirements

Education:   

  • College degree in Business preferred

Years of Experience:  

  • At least three (3) years with excellent customer service experience
  • Preferred One (1) - two (2) years in the healthcare field

Specialized Knowledge:  

  • Knowledge of Medicaid and Medicare programs preferred
  • Knowledge of health plan programs desirable

Skills & Abilities:

  • Proficient in usage of Microsoft Windows applications
  • Strong customer service skills and techniques
  • Strong presentation and oral & written communication skills
  • Excellent ability to plan and organize
  • Strong ability to function independently, and be part of a team

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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