Provider Service Representative - Utah Market
Company Name:
Iasis Healthcare
### Job Description
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
The Network Services 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 negotiating 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 plan 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 and other providers in an assigned area to assure adequate medical services for Health Choice members:
Analyze and evaluate network coverage to identify network needs
Review contracts and proposals to determine proper reimbursement
Negotiate fees and create contracts
Obtain information from providers to begin the credentialing process
Provide face-to-face, written and telephone communication to providers:
Meet with providers to identify, discuss, and resolve various issues, respond to provider requests for research and resolution of complaints.
Disseminate/communicate information to internal colleagues and communicate significant or important information to appropriate departments.
Consult with Medical Services to ensure providers are following proper medical procedures.
Interact with Claims Dept regarding payment schedules and rates of reimbursement.
Perform initial orientations and ongoing in-service/education to providers.
Familiarize key staff with Health Choice policies and procedures.
Inform providers of policy changes and/or new policies.
Ensure providers are following proper medical procedure and referral, information/authorization, covered service guidelines, and submission of claims.
Develop written materials to assist providers in following Health Choice procedures. Perform other duties as assigned:
Assist with development and distribution of Provider Manual,
Assist with provider newsletters.
Assist with writing contracts, amendments and letters of agreements, and other documents and projects as required.
Perform a variety of other duties as assigned.
Maintain and ensure provider demographic information is complete and up to date:
Identify and make updates and corrections to demographics as they are identified or as received from the provider.
### Skills / Requirements
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
Education:
High School Diploma or GED equivalent
College Degree preferred
Experience:
At least two (2) years customer services or claims experience with a managed healthcare plan
A minimum of two (2) years contract analysis and negotiating experience required
Certification and License:
Current driver s license, reliable transportation, and current insurance coverage required
Posted: 12/08/2014
Job reference #: 1406840Estimated Salary: $20 to $28 per hour based on qualifications.
Iasis Healthcare
### Job Description
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
The Network Services 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 negotiating 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 plan 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 and other providers in an assigned area to assure adequate medical services for Health Choice members:
Analyze and evaluate network coverage to identify network needs
Review contracts and proposals to determine proper reimbursement
Negotiate fees and create contracts
Obtain information from providers to begin the credentialing process
Provide face-to-face, written and telephone communication to providers:
Meet with providers to identify, discuss, and resolve various issues, respond to provider requests for research and resolution of complaints.
Disseminate/communicate information to internal colleagues and communicate significant or important information to appropriate departments.
Consult with Medical Services to ensure providers are following proper medical procedures.
Interact with Claims Dept regarding payment schedules and rates of reimbursement.
Perform initial orientations and ongoing in-service/education to providers.
Familiarize key staff with Health Choice policies and procedures.
Inform providers of policy changes and/or new policies.
Ensure providers are following proper medical procedure and referral, information/authorization, covered service guidelines, and submission of claims.
Develop written materials to assist providers in following Health Choice procedures. Perform other duties as assigned:
Assist with development and distribution of Provider Manual,
Assist with provider newsletters.
Assist with writing contracts, amendments and letters of agreements, and other documents and projects as required.
Perform a variety of other duties as assigned.
Maintain and ensure provider demographic information is complete and up to date:
Identify and make updates and corrections to demographics as they are identified or as received from the provider.
### Skills / Requirements
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
Education:
High School Diploma or GED equivalent
College Degree preferred
Experience:
At least two (2) years customer services or claims experience with a managed healthcare plan
A minimum of two (2) years contract analysis and negotiating experience required
Certification and License:
Current driver s license, reliable transportation, and current insurance coverage required
Posted: 12/08/2014
Job reference #: 1406840Estimated Salary: $20 to $28 per hour based on qualifications.
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