Provider Performance Representative
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
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.
- 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
- 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
- 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
Job Status: Full Time
Job Reference #: R397