Provider Relations Representative West Central Fl

3 weeks ago

Central Florida, United States Alivi Full time
Job DescriptionJob DescriptionSUMMARYThe Provider Relations Representative serves as the primary liaison between Alivi and our network of NEMT Providers. The Provider Relations Representative will provide training, education and guidance while building a strong relationship with our provider partners by in-person or virtual visits, and phone calls. The Provider Relations Representative is responsible for ensuring network adequacy by identifying, attracting, negotiating, and contracting quality specialty providers.

 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.
REQUIREMENTS & QUALIFICATIONS
  • 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
Remote position with travel as needed within Hillsborough County and surrounding areas

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