Provider Engagement Administrator II
6 days ago
Description
• Serve as primary contact for providers • Act as a liaison between providers and the health plan • Triages provider issues for resolution to internal partners • Receive and respond to external provider related issues • Investigate, resolve and communicate provider claim issues • Educate providers regarding policies and procedures related to referrals and claims submission • Perform provider orientations and ongoing provider education • Manages Network performance for assigned territory • Evaluates provider performance and develops strategic plan to improve performance • Drives provider performance improvement in risk/P4Q, Health Benefit Ratio, HEDIS/quality, cost and utilization • Present detailed HBR analysis and create reports for Joint Operating Committee meetings • Develop proficiency in tools and educate providers on use of tools • Coaches new and less experienced External Reps • Completes special projects as assigned • Ability to travel locally 4 days a week • Performs other duties as assigned • Complies with all policies and standards
Requirements
• Bachelor’s degree in related field or equivalent experience • Three years of provider relations, provider claims/reimbursement, or contracting experience • Knowledge of health care, managed care, Medicare or Medicaid • Bachelor’s degree in healthcare or a related field preferred • Claims billing/coding knowledge preferred
Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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