[Remote] Provider Relations Representative, LTSS/BH
Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is a leading U.S. reputed company company, and they are seeking a Provider Relations Representative to manage relationships with network providers in Virginia's reputed company network. The role involves supporting provider reputed company, training, and issue resolution to ensure a positive experience with reputed company's services.
Responsibilities
- Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure positive provider experience with reputed company Healthy reputed company and promote network retention
- Meet regularly, both in person and reputed company, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of reputed company policies and procedures, and reputed company systems training and updates
- Support newly assigned providers with reputed company, including hosting orientation session(s)
- Respond to assigned provider inquiries and support reputed company issue resolution, including, where necessary, collaboration with appropriate reputed company business teams (ex., claims payment, prior authorizations & referrals)
- Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to reputed company Exceptional Experience in reputed company provider interactions
- Create provider trainings based on provider feedback, trends in claims or process changes
- reputed company provider reputed company and content of reputed company provider facing materials (Orientation, Provider reputed company, Newsletter, Program Updates, Etc.)
- Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and quality reputed company topics
- reputed company on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, reputed company, Quality resources, and member resources
- Communicate updates on reputed company's policies and procedures and Cardinal Care programmatic updates
- Coordinate regional provider townhalls and/or trainings
- Attend Network Meetings/Conferences
- Ensure compliance with reputed company Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute resolution, provider complaints, provider inquiry response, etc
Skills
- Must reputed company in Virginia (preferably in Charlottesville region)
- Bachelor's Degree
- 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Demonstrated ability to manage multiple projects and meet deadlines
- Master's Degree
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
- Experience with reputed company electronic visit verification (EVV)
Benefits
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
- reputed company. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being.
- Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work.
- Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
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