Senior Physicians Network Representative

Position Summary:

Dynamic, service-oriented, detailed individual to implement the operational deliverables for the physician networks and support the Assistant Administrators and Administrators in managing the financial and operational activities of the contracted networks of physicians.

Involving extensive interaction with Administrators and network providers, 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 time be spent 70% at a minimum externally, with heavy administrative support and may include some overnight travel.

 

Essential Job Functions:

1. Administrative Support:

a) Take incoming calls, as transferred primarily from Customer Service and other departments.

b) Research and resolve provider issues:  Including, but not limited to:

?  MSM inquiries

?  claims payment issues

?  contracting questions

?  fee schedules inquiries

?  changes that affect billing information and/or practice locations

?  referral issues

?  RA issues

?  Claim denial documentation

?  check tracer requests

?  EDI issues

?  General education (e.g. co-pay structure, plan types, par facilities, etc.)

?  Fulfilling form requests (e.g. referral forms, EDI applications, directories, manuals, change forms, formularies)

a) Complete and implement Action Items within designated time frame.

b) Responsible for identifying trends/issues that may be effecting providers and communicate resolution/issue to the appropriate team member.

2. Meeting preparation:

a) Overall responsible for the readiness of Board Meetings deliverables

b) Overall responsible for the readiness of Financial Review Meeting deliverables

c) Facilitation of UM/QM or other Committee meetings

3. Monthly Capitation Distribution

?  Responsible for Reports from Finance/Business Support with Provider Relations/Assistant Administrator

?  Responsible for Verification of Reports with Cap Detail and Check Information

?  Responsible for Information to be distributed with Monthly Capitation

?  Responsible for Distribution of Monthly Materials to Contracted Providers

?  Responsible for Provider Matrices and Rosters

4. Contracting

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

?  Assist with provider contracting up to execution of agreement

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

5. True-Up/Bonus Distributions

?  Responsible for Packets to be distributed to Physicians

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

?  Strong analytical skills

?  Strong attention to detail

?  Communication to providers regarding outcomes/opportunities

6. Network DevelopmentAbility to understand and foster complex business relationships Access to confidential informationAnalyze information and target trendsBusiness analysisConduct meetingsCoordinate events/meetingsDevelop/Maintain networks

7. Special Projects

?  Assistance with Provider Relations/ Administrators on Special Project Needs

?  Ability to perform duties that are structured and specific

?  Ability to train othersContinually seek ways to provider better customer service.Effective in groups, identifying problems and solutionsHandle multiple tasksOrganize people to achieve goalsPeople managementProblem solvingProject management

8. Day to DayAnswer telephoneCompose letters/memosStrong communication skills ? written and verbalStrong customer service skillsStrong organizational skillsTeam building skillsTime managementWell developed interpersonal skills

9. Internal Liaison between Operations and other HealthSpring Departments

 

Other Duties:

This position may require overnight travel.

While this job description is intended to be an accurate reflection of the duties involved in this position, the company reserves the right to add, remove or alter duties when business need dictates. Minimum Requirements:

?  Bachelor?s Degree required.

?  Healthcare industry/physician experience - Experience in managed care environment preferred

?  A determination to excel and work in a team environment

?  Demonstrated analytical skills

?  Strong organizational abilities with attention to detail required

?  Strong Microsoft Word and Excel skills

?  Claims payment understanding and/or contracting experience.

?  Minimum of 4 years experience in Healthcare industry or related field preferred.

 

Physical Demands:

This job requires sitting for extended periods of time due to phone contact and lifting and carrying materials to meetings.

The physical demands described below are representative of those that must be met by the employee to perform the essential functions of the job.  If requested, reasonable accommodation may be made to enable individuals with disabilities to perform essential job functions.

 

While performing the duties of this job the employee is regularly required to sit, stand, walk, talk, hear and see.  The employee must use both hands to feel and operate a computer keyboard.  The vision requirements include:  close vision, distance, vision, peripheral vision, depth perception and ability to focus.

 

HealthSpring offers a competitive salary and a full range of benefits.

 

To be considered, visit www.myhealthspring.com,

click Apply & complete an online application.

 

All interested applicants must complete an application.

 

Select Department: Network Operations

Select Position:Senior Network Operations Representative

Attach resume

 

Include salary history/requirement. No phone calls accepted.

 

HealthSpring, Inc. is an EEO/AA employer.