Robert Half Office Team Provider Network Relations Specialist in MECHANICSBURG, Pennsylvania
Provider Network Relations Specialist
Position Purpose: Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship. Duties of the Provider Network Relations Specialist
Conduct initial provider orientations as well as ongoing educational outreach
Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
Enhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence.
Engage providers and educate them on Patient Centered Medical Home initiatives
Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factors
Create and communicate milestone documents, dashboards and success or improvement metrics
Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
Provide information and status updates for providers regarding incentive agreements
Conduct site visits when required
Perform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special projects
Ability to travel Requirements: Bachelor's degree in related field or equivalent experience. 2+ years of combined managed healthcare and provider reimbursement experience. Advanced knowledge of Microsoft Excel. Clinical or health information management (HIM) experience preferred. Claims processing and/or managed care experience preferred. Licenses/Certifications: Current state driver's license.
OfficeTeam is the world's leader in quickly matching skilled administrative professionals with temporary and temporary-to-full-time jobs. We offer job opportunities ranging from executive and administrative assistants to customer service representatives, receptionists and general office support. Our staffing managers connect with more than 100,000 hiring managers in North America every single week. In addition to free job search services, we provide access to free online skills training and a competitive benefits and compensation package.
Our parent company, Robert Half, once again was named to FORTUNE® magazine's list of "World's Most Admired Companies" and was the highest-ranked staffing firm. (March 1, 2016)
Contact your local OfficeTeam branch at 888.981.6731 or visit roberthalf.com/officeteam to apply for this job now or find out more about other job opportunities.
All applicants applying for U.S. job openings must be authorized to work in the United States. All applicants applying for Canadian job openings must be authorized to work in Canada.
Equal Opportunity Employer M/F/Disability/Vet
Req ID: 03750-0008945490
Functional Role: Administrative - Medical
Postal Code: 17055-6922
Compensation: $20.00 to $28.00 per hour
Requirements: MS Excel, Report Generation, Prepare Presentations, Training - Presentation, Benefits Coordination, Benefits Administration