What are the responsibilities and job description for the Provider Relations Specialist / Network Development for TPA position at Behavioral Health Systems, Inc.?
Summary: Under the general direction of the Vice President, Provider Relations, this position is responsible for continued development of PPO network, PPO rate negotiations, and orientation of providers.
Specific Duties:
Under the direction of the Vice President, Provider Relations, and in cooperation with the Director, Provider Relations and all divisions as deemed appropriate:
1. Develop, expand and maintain PPO network, to include new provider identification, solicitation and rate negotiation. Adhere to established provider fee schedules. Coordinate rate negotiations with Vice President, Provider Relations and Director, Provider Relations and Executive Vice President and Chief Financial Officer.
2. Assist in conducting BHS provider orientations, to include individual and regional provider training sessions, as requested.
3. Serve as liaison with treatment providers, clients, patients, and others, as requested. Resolve problems on a timely basis.
4. Provider Relations Division serves in direct support role to the Clinical Division. Assist Clinical Division as directed in client/case-specific provider hook-ups and problem-solving.
5. Assist Clinical Division and Accounting/Marketing Divisions as requested in support services related to specific or potential client contracts. Assist in preparation of proposals as requested.
6. Maintain corporate, departmental and quality assurance policies and procedures. Recommend new policies/procedures as deemed appropriate. Recommend revisions to PPO contract forms and rates as appropriate.
7. Participate in on-going marketing and provider relations efforts, as directed. Participate in special projects, on-going research and public relations efforts as appropriate. Coordinate information on competition, provider rates by region or city, national statistics and relevant changes in the field with Vice President, Provider Relations. Make recommendations on product line enhancements. Prepare reports as requested.
8. Perform other related duties as directed or deemed appropriate. Attend meetings as requested. Advise Vice President, Provider Relations on developments in the field.
Qualifications:
- Bachelors in related field.
- Three years provider relations experience required, preferably with PPO/HMO or similar setting.
- Experience in managed care/PPO environment.
- Some experience/involvement in mental health field and public relations preferred.
- Familiarity with case management/util. review functions.
- Familiarity with computerized applications (PCs, Word, Access and the internet).
- Experience in services to business, industry preferable
- Experience with fiscal issues, rate negotiations, contractual terms.
- Excellent communication skills (written and oral) and organization skills.
- Experience in group presentations/speaking preferable.
- Excellent problem-solving abilities.
- Willing to perform extensive telephone work.
- Professional appearance.
- Cooperative attitude and self-starter. Assertive. Goal-oriented.
- Alabama driver’s license and dependable transportation. Ability to travel.
Job Type: Full-time
Pay: $62,010.00 - $64,515.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- Provider Relations: 3 years (Required)
Ability to Relocate:
- Birmingham, AL 35209: Relocate before starting work (Required)
Work Location: In person
Salary : $62,010 - $64,515