Provider Relations Representative Palm Beach FL
3 weeks ago
DUTIES & RESPONSIBILITIESProvider Network Management
- Functions as the single point-of-contact for all issues related to the network.
- Performs root cause analysis and resolution on provider related complaints, claims reported to have been processed incorrectly, claim rejections, payment issues, etc.
- Facilitates provider education and training to increase their familiarity and satisfaction with systems, policies, and procedures.
- Ensures provider adherence to the Provider Manual.
- Manages providers in multiple markets, regions, counties.
- Visits providers in person for relationship building and for training and education purposes
- Preforms in person site inspections as needed
- Assists in compiling, communicating, and mailing general materials to network providers as required.
- Manages multiple tasks, detail-oriented, responsive, and critical thinking.
- Establish and complete monthly touchpoints and conduct quarterly business reviews with network providers.
Network Adequacy
- Conducts research and contacts qualified providers by phone, email, or in-person to target adequacy gaps and hot spots.
- Effectively recruits, negotiates, and contracts providers from multiple lines of business.
- Maintains provider network adequacy in assigned region(s)
- Gathers all provider/facility credentials and submits a complete file to the credentialing department.
Field Inspector
- Perform detailed vehicle inspections to ensure compliance with safety standards and operational guidelines.
- Complete CTAA PASS certification to understand and adhere to safety protocols during inspections.
- Ensure familiarity with wheelchair vehicle components and proper member securement techniques.
- Gather information and observations related to unsafe circumstances, service complaints, provider behavior, or vehicle condition/performance.
- Investigate complaints or issues reported by members or facilities and Document and report findings to facilitate appropriate corrective action.
- Identify and evaluate additional providers in specific areas.
- Observe provider behavior on the road and at facilities, including loading and unloading procedures. Assess proper levels of service (LOS), member securement, safety practices, and On-Time performance (OTP) by provider.
- Serve as a resource for facilities by making regular visits and introducing yourself to facility staff.
- Address service issues or failures by coordinating with providers and facilities to implement resolutions.
- Foster and improve relationships between facilities and providers through effective communication and problem-solving.
Other
- Conveys a strong professional image, exhibits interest, and a positive disposition in all aspects of the role.
- Maintains an accurate provider database of leads and accounts for all networks.
- Leverage SalesForce CRM tool to maintain all provider/vendor accounts, documents, notes, and communication.
- Be the Alivi Brand Ambassador for network providers.
- Travel to network provider offices/facilities.
- Other duties as assigned.
- High school diploma or equivalent.
- Fluent in English, and Spanish would be a plus.
- 2 years of related experience and/or training.
- Experience with Microsoft Word, Excel, PowerPoint, and Outlook.
- Self-starter, able to work independently and handle ambiguity.
- Strategic, analytical, process-oriented with critical thinking skills.
- Excellent written and verbal communication skills.
- Strong Customer Service orientation.
- Ability to work independently or in a team environment.
- Excellent problem-solving skills, good follow-up abilities, and willingness to be flexible and adaptable to changing priorities.
- Experience in customer service, claims processing, claims auditing or provider relations for Provider Networks in Podiatry and/or Chiropractic is desirable.
- Proficiency in creating and analyzing Network Adequacy reports is desirable. Experience presenting to a variety of audiences is desirable.
- Experience with Medicare Advantage, Managed Medicaid, and Commercial health plans is desirable.
- CTAA PASS certification (or willingness to obtain upon hire)
- Strong understanding of vehicle safety and inspection protocols.
- Ability to work independently and collaboratively in the field.
- Excellent observational and investigative skills
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