Provider Relations Specialist
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Job Type
Full-time
Description
The Provider Relations Specialist is responsible for maintaining and improving existing provider relationships through communication, provider support, analysis, problem solving and education in support of the NIOSH World Trade Center Health Program.Works directly with providers to ensure they are serviced, maintained and educated on all policies and procedures in an efficient, positive and professional mannerCollaborates with both internal and external stakeholders to meet existing and newly identified needs of the providers and their patientsMaintains a comprehensive provider contact database comprised of multiple tracking reportsBuilds relationships with each of the Clinical Centers of Excellence (CCEs) to coordinate provider nomination requests and pursuit status, prescriber authorizations, and ongoing support for the membersAssists with incoming inquiries through the dedicated Provider Enrollment mailbox and ServiceNow tickets escalated by the Call Center to address provider inquiries such as requests for Remittance Advice (RA) statements, claim denial reviews due to provider enrollment issues, etc.Works with appropriate stakeholders on timely resolution of provider grievancesSupports the secure exchange and organized management of all provider enrollment documentation, including Terms & Conditions Agreements, EFT and W9 forms, and related documentationAssists with ensuring providers are compliant with all program requirements per the terms of their agreement regarding availability and access standards, evaluating compliance as requiredProvides education, coaching and guidance to providers on required metrics, programs and other quality initiativesTakes full ownership of a provider’s recruitment, enrollment and participation experience, including outreach, education, sending / receiving / processing agreements, liaising with the CCE as appropriate, and responding to claims status inquiriesEnsures provider records are updated timely with requested changes to a provider’s demographic information, contract status, updates are sent for processing timely and ensures updates are performed accurately within the systemPerforms research and analysis on pended / escalated claims, working with appropriate departments and providers to find resolution
Requirements
BA/BS preferred, equivalent experience in lieu of degree2-5 years’ experience in healthcare, particularly provider support or educationExperience working with multiple system applications in an end-user capacityExperience developing communication materials for professional audiencesAdvanced analysis and problem-solving skillsExcellent written and verbal communication skillsPM18
Salary Description
$80k - 90k / year
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