Responsibilities

Job Summary: The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within the provider network, including oversight & managing performance in various incentives based and/or value-based programs. Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with Prominence Health Plan and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem solving as necessary.

Qualifications

Job Duties/Responsibilities:

• Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on topics including, but not limited to health plan operations/policies and procedures, preventative & quality outcome metrics & risk adjustment.
• Responsible for understanding, developing, tracking, monitoring and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures. 
• Prepares for and participates in meetings with providers and provider staff and plans, creates & delivers agendas and/or presentations. 

Requirements:

• High School Graduate/Equivalent
• Knowledge of provider reimbursement, Medicare reimbursement, coding and Hedis Measures and care gap reporting preferred.
• Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan’s success
• Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff
• Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)
• Understanding of health plan departments and functional areas for problem resolution
• Experience in customer service/relations-like roles
• Ability to effectively communicate in English, both verbally and in writing.
• Proficient in Microsoft Office skills (Excel, Word, Access, etc.)
• Enjoys working in both individual and team settings
• Problem solver – enjoys problem solving
• Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
• Good communication and relationship skills
• Strong analytical skills
• Attention to detail
• High level of energy