About the job
As a Provider Network Representative, you will serve as the primary liaison between healthcare providers and our health plan. Your responsibilities will include scheduling, organizing, and facilitating collaborative Joint Operating Committee (JOC) meetings. You will conduct orientations for both individual providers and larger provider groups, ensuring they are equipped with the necessary information and education on our services and policies. Regular travel to provider offices is required, so a valid driver's license is essential.
Position Purpose: Act as an intermediary to foster communication between healthcare providers and the health plan, performing training and coaching to enhance network performance and assist with claim resolutions.
Key Responsibilities:
- Serve as the primary contact for healthcare providers, liaising between home and community-based services and the health plan.
- Conduct monthly in-person meetings with provider representatives, documenting discussions, addressing issues, and resolving claims where possible.
- Schedule, organize, and facilitate collaborative JOC meetings as necessary.
- Address and resolve external provider-related inquiries effectively.
- Educate providers on innovative contracting strategies offered by the health plan.
- Manage data entry of provider demographic changes and oversee the completion of change requests for the network.
- Investigate, resolve, and communicate updates about provider claim issues and changes.
- Guide providers on policies and procedures concerning referrals, claims submission, website usage, and related topics.
- Conduct orientations for individuals and diverse provider groups, updating and presenting orientation materials as necessary.
- Be prepared to travel frequently.
