Provider Consultant

The Provider Consultant will be overseeing the Houston area. Ideal candidate will be goal oriented, have a background in healthcare, and have the ability to drive results. This position is responsible for the following:

• Serve as the primary liaison between the network and the participating provider community who service our members via multiple product lines


• Build and maintain strong relationships with providers by offering excellent customer service to assigned primary care, and specialty care physicians with routine and targeted education visits for the purpose of continued education regarding policies/initiatives.


• Conduct on-site visits, telephonic conversations and written communications with individuals including Hospital executives, Patient Account Managers, Physicians, Office and Billing Managers.


• Arrange implementation and execution of the patient’s necessary discharge planning to next level of care.


• Coordinate patient care from post-acute facility to patient’s home or next level of care.


• Track patients through throughout the post-acute continuum of care and develop and foster relationships with these agencies.


• Identify trends at the facility or post-acute level that prevent patients’ from receiving high quality care.


• Communicates the expected LOS to SNF for waiver and work closely with facility staff to coordinate patient care plans.


• Creatively reach out and engage patients to meet their needs while highlighting cost-savings.


• Other duties as assigned.


• Applicant must be highly proficient and creative at identifying and solving problems.


• Incumbent must be able to work independently as a telecommuter and attend off-site meetings, including overnight stays.

Essential Job Functions:

• Communicate effectively as a liaison between the provider community and PBACO in order to provide education on policies and procedures as well as, to assist in the resolution of issues or concerns a provider may have.


• Provider Orientations: Perform on-site provider orientations for primary care, specialty care physicians regarding policies, procedures, billing and company-wide initiatives within 30 days of becoming credentialed and approved.


• Oversee group county provider orientations by determining location, arranging for mailing of invitations and make available at the presentation PBACO provider forms, QI Manuals, directories and the PBACO Provider Office Policy and Procedure Manual, as needed.


• Goal/Target Visits: Service primary care, and specialty care physicians within a specific geographic territory by conducting annual Goal / Target visits for the purpose of continued education regarding policies/initiatives.


• Communicate effectively as a liaison between PBACO and the SNF/HHA community in order to provide education on policies and procedures as well as, assist in the resolution of issues or concerns between PBACO and any agencies.


• Coordinate patient care from post-acute facility to patient’s next level of care. Liaison between PBACO and the post-acute facility to ensure proper care plans, communication, and follow-up.


• Goal / Target Visits: Service SNF/HHA within a specific geographic territory by conducting annual visits for the purpose of continued education regarding policies/initiatives.

Minimum Qualifications:

• 2 years’ experience required in Provider Relations, Home Health Setting, SNF, and/or Managed Care Product Administration


• Valid unrestricted driver’s license

Preferred Qualifications:

• Bachelor’s degree in Business Administration, Marketing, Health Care Administration or Other Related Degree


• 2 years’ Provider Relations experience or medical office or hospital experience


• 2 years’ exposure to medical claims processing procedures


• Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure.