Sr Provider Relations Coordinator

Assists with provider network development, servicing and maintenance within a defined territory. Acts as liaison and support between medical providers, IPAs, Hospitals, HMO credentialing staff and administration. Reports to Director, Network Management.

1. Assists in contract negotiations with individual medical providers. Ability to draft contract language under direction of Director, Network Management.
2. Identifies network needs for service area coverage and assists in new provider recruitment.
3. Develops in-service training materials and performs in-service provider meetings and orientations concerning company benefit plans, provider credentialing, Quality Assurance Programs, administrative procedures, managed care philosophy and other policies.
4. May conduct visitations to provider offices. Acts as a resource and support person to IPA/Medical Group and Hospital operational staff in the resolution of provider questions and problems.
5. Supports the Provider Relations Call Center by handling calls, email and mail as it relates to IPA, Medical Group and Hospital operational staff. May be required to look up contract info in files to resolve issues.
6. Performs processing function of contracts with credentialing information that comes in.
7. Processes delegated Medical Group profiles.
8. Assists in provider directory development and maintenance. Responsible for collecting updates from provider network and assuring accuracy of data prior to the printing of a directory.
9. Assists in the maintenance of provider files working closely with credentialing staff and others to identify network changes and required PIMs updates.
10. Supports activities of sales offices by establishing strong rapport with sales office staff to assist in resolving network questions and issues with employer groups. Support includes education/training of sales office staff on network updates and changes.
11. Assists in resolution of provider complaints and follow-up including correspondence.
12. Develops strong rapport with Claims Offices(s) in coordination of provider updates and provider problem resolution.
13. Other project work and responsibilities as required.

Qualifications:
1. High School Diploma or equivalent. College degree or 3 years managed care experience required.
2. Demonstrated strong organizational, analytical and problem-solving skills.
3. Excellent oral and written communication skills including public speaking and oral presentation skills, and experience drafting effective/accurate written correspondence to all levels of professionals.
4. Previous experience conducting effective training and information sessions.
5. Interest in and orientation toward developing negotiation skills.
6. Ability to work independently completing multiple tasks successfully with minimal direct supervision.
7. Computer experience in MS Word, Excel, PowerPoint, and e-mail; accurate data entry & typing skills.
8. Local travel in personal vehicle may be required.

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