Open Position

Provider Relations Assistant

Job Description

Answer incoming calls from claims, customer service, members and/or providers regarding questions on network providers, billing/tax ID information, fee schedules, and other provider issues.  Research and resolve any issues.

• Answer incoming calls from claims, customer service, members and/or providers regarding questions on network providers, billing/tax ID information, fee schedules, and other provider issues.  Research and resolve any issues.
• Organize, understand, and maintain PPO provider contracts.
• Research and enter all provider set-ups and/or contracts in claims system and/or provider databases.
• Research and data input all address changes, tax ID changes and billing changes for providers.
• Identify and recruit providers for PPO network(s).  Prepare contract packets and mail to potential providers.  Follow-up with potential providers to determine their willingness to participate in the network.
• Process and analyze new provider contracts for completeness.  Follow-up on any missing application/contract information.  Prepare contract file and maintain integrity of all provider contract files.
• Ensure all credentialing processes are performed according to policies and procedures and are completed within the statutorily mandated timeframes.
• Research and perform data input of provider information for PPO Networks used by TPA clients.
• Establish, maintain and distribute network provider information within department as well as to clients.  Maintain all Provider Directory databases.
• Work with claims staff and Contract Analyst to research/resolve PPO network contract issues identified during claims payment process.
• Serves as a backup to the Customer Service Assistant and requests for funding or benefit release processes.
• Serves as a backup in processing HSA and FSA claims and debit card processes.
• Maintain highest level of confidentiality in work processes.
• Other projects/duties as assigned by the Manager.

Job Duties

• High level of initiative and motivation.
• Detail oriented, accurate and analytical.
• Ability to manage multiple projects and operate in a fast paced environment.
• Ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action.
• Excellent organizational and prioritization skills.
• Excellent written and verbal communication skills.
• Exhibits high level of professionalism and the ability to work with healthcare professionals/executives at all levels.
• Excellent interpersonal skills to effectively handle upset providers.
• Ability to establish rapport and work well with others.  Positive attitude.
• Ability to maintain confidentiality in work processes.
• Demonstrate initiative to increase knowledge and skills to keep pace with changes in business.
• Respond well to direction and require little direct supervision in completing duties.
• Have transportation available if needed for outside meetings.
• Experience with Microsoft Office applications with at least an intermediate level of proficiency.  Advanced skills preferred.
• Administrative experience in healthcare or a related environment preferred. Knowledge of provider contracts and provider credentialing a plus.
• High School diploma required.  Post HS education or formal training a plus.

Submit resume w/references to:

hiringteam@coxinet.net