Provider Relations Representative

The Internal Provider Relations Representative will be a dynamic, detail-oriented individual to support the internal operations of the Provider Relations Representatives, Assistant Administrators, and Administrators in managing the financial and operational activities of the contracted networks of physicians.

 

Involving extensive interactions with Administrators and Provider Relations Representatives, this position will provide a broad overview of managed care and the many aspects involved in effective management (financial understanding, network building, conflict/issue resolution, etc.).  Position requires that the majority of time be spent internally.

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Responsibilities:

Support of the Operations department in:

v Meeting preparation

?  Board meetings

?  Preparation of Agendas and Packets

?  Coordinating Follow Up Items from Board meetings

?  Financial Review Meetings

?  Assistance in Preparation of Packets

?  UM/QM or other Committee meetings

?  Assistance in Preparation of Packets

v Monthly Capitation Distribution

?  Coordination of Reports from Finance/business Support with Provider Relations/Assistant Administrator

?  Verification of Reports with Cap Detail and Check information.

?  Assistance with Preparation of Information to be Distributed with Monthly Capitation.

?  Assistance with Distribution of Monthly Materials to Contracted Providers

?  Maintenance of Provider Matrices and Rosters.

v Contracting

?  Maintenance of Provider Contract Files (including contracts, exhibits, etc.) and Overview of Processes.

?  Coordination with Credentialing/Business Support to Insure Providers are Loaded correctly.

v True-Up/Bonus Distributions

?  Assistance with Preparing Packets to be Distributed to Physicians.

?  Coordination with Finance/Business Support in Obtaining and Sorting Necessary Reports. 

v Special Projects

?  Assistance with Provider Relations/Administrators on Special Project Needs.

v Internal Liaison between Operations and other GulfQuest Departments. 

 

Requirements include:

?  College degree preferred.

?  Managed care experience preferred (1 year) or 2 years work experience in office environment.

 

HealthSpring offers a competitive salary and full range of benefits