External Provider Relations Representative

Apex Health Solutions

Houston, TX 77007

Posted 1 month ago

Job Description

Summary The External Provider Relations Representative will be responsible for ongoing education and service to physicians and provider networks as assigned. Establishes and maintains ongoing relationships with the health plan’s network of physicians, hospitals and ancillary providers. Serve as primary contact for providers serving as a liaison between the provider and the health plan. Essential Duties and Responsibilities include the following. Other duties may be assigned. Coordinates and conducts new provider orientations. Educates and provides customer support to top 20% network physicians and ancillary providers. Communicates policy revisions (and updates) to all providers. Conducts meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution. Performs on-site credentialing visits. Will require the ability to travel. Assists with monitoring of provider contracts. Initiate entry or change of provider related database information and oversee testing and completion of change request. Provide updates of demographic and billing information to applicable department(s). Assists with resolving administrative problems affecting network providers within contracted guidelines for which the network is responsible. Attends regular Credentialing meetings. Acts as intermediary between Apex Health Solutions and providers to record provider complaints and actively work to resolve provider issues. Assists in conducting accessibility monitoring of contracted provider offices on-site and after hours. Communicates, collaborates and cooperates with internal and external stakeholders. Adheres to all Compliance/Program Integrity requirements. Complies with HIPAA Regulations. Ensures safe care to patients, staff and visitors; adheres to all Apex policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Minimum Qualifications Education: Bachelor’s Degree required Licenses/Certifications: (None) Experience / Knowledge / Skills: Three (3) years’ experience in network management; customer service or provider relations in a managed care environment Intermediate level of proficiency in claims processing and issue resolution. One or more years of experience with Medicare and Medicaid regulations. Experience in managed care provider contracting /negotiations Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement Exceptional presentation, written and verbal communication skills Ability to work independently and remain on task Strong problem-solving skills and interpersonal skills. Good organization and planning skills Ability to prioritize and meet deadlines from multi-staff members within the department Intermediate level of proficiency with MS Word, Excel, PowerPoint and Access



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