Provider relations representative job description

Job Title: Provider Relations Site Visit Coordinator
Duration: 06 Months Contract
Location: Dallas-Fort Worth Metropolitan Area, TX, Houston, TX, McAllen, TX

Job Summary:
The Provider Relations Site Visit Coordinator will serve as a physical site coordinator and will be required to communicate with healthcare providers through verbal and written communications.
The Site Visit Coordinator will be responsible to conduct pre- enrollment, post enrollment and address change site visits at healthcare providers physical office locations.
The position requires high level literacy, communication, critical thinking skills, reliable transportation with frequent travel within territory, excellent time management skills, solid judgment, and a strong work ethic.

Key Responsibilities are as follows:
Conduct face to face scheduled and unscheduled visits within the provider community.
Maintain a working knowledge of Medicaid program and policy, online provider resources, internal processes and technological applications.
Independent management of local territory by utilizing various reporting methods.
Meet all contractual obligations while establishing and maintaining positive interpersonal relations.
Develop interpersonal relationships with peers and workgroups while working remotely.
Participate in team training and workgroups in addition to individual territory responsibilities.

Job Qualifications:
Minimum of 1 year of experience working directly with healthcare providers.
High School diploma or equivalent.
Ability to self -monitor.
Proficiency in Microsoft Office suite.
Working knowledge of Medicaid, Medicaid manage care, and or commercial health plan managed care.

Special Job Requirements: In-home Remote worker. Minimum of 75% travel. Must reside in the assigned territory including the following Counties.

Schedule: Monday thru Friday; 08:00 AM to 05:00 PM CST.

Company DescriptionCollabera is a Global Digital Solutions Company providing Software Engineering Solutions for the world's most tech-forward organizations in the areas of Engineering, Cloud and Data/AI. With its roots serving the engineering needs of the world's most recognized businesses in Technology, Financial Services, Telecom and Healthcare, Collabera today operates across 60 locations in 11 countries, serves 30% of the Fortune 500, and has exceeded the industry growth rate by 3-4x for several years.

The Provider Relations/Engagement Professional 2 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities

The Provider Relations/Engagement Professional 2 will be responsible for:

Visiting w/Provider face to face and virtual, educating providers on policies and processes, building relationships, educating providers on the use of online tools and resources, monitoring reports and documenting provider encounters Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Must be passionate about contributing to an organization focused on continuously improving consumer experiences Follows established guidelines/procedures.

Required Qualifications
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 Intermediate to advanced computer skills and experience with Microsoft Word, Excel, Outlook and Power PointStrong verbal and written communication skills Strong organization and prioritization skills Experience working with Providers Office, Hospitals, Conferences, Seminars, Town Halls and other community based events Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Must be available to work a flexible schedule for Association Events otherwise the schedule will be Monday - Friday and require a minimum of 3-4 days travel a week in your local area Training date 10/10/22

Work-At-Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role.A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel
This position will require a minimum of 3-4 days a week in your local area - New Orleans and Baton Rouge areas Must have a Valid driver's license with reliable transportation and the ability to travel within the state, as required This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications
Experience with Physical or Behavioral HealthWorking with Louisiana MedicaidComprehensive knowledge of Medicaid policies, processes, and procedures

Additional Information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

#LI-KK1 #LouisianaMedicai

Scheduled Weekly Hours

40

Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.

Provider Inquiry/Services staff are responsible for the submission, research, and resolution of provider inquiries and/or disputes. They respond with the answer to all incoming inquiries and coordinate with other Molina departments as needed to resolve the issue, as well as to correct the underlying cause, ensuring that resolutions are timely and in compliance with all regulatory requirements.
KNOWLEDGE/SKILLS/ABILITIES



Resolves and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies.
Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider problem areas.
Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
Interfaces with other departments regarding questions about provider configuration or other relevant provider issues.
Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements.
Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals.
Monitors each request to ensure all internal and regulatory timelines are met.



JOB QUALIFICATIONS


Required Education


High School diploma or GED equivalent


Required Experience


1-2 years' experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience.


Preferred Education


Associate degree in Business and/or completion of a vocational program in Managed Care or some other health care aspect providing a certificate at completion.


Preferred Experience


2-3+ years managed care experience.


Preferred License, Certification, Association


CPC certification



To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.


Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.


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