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Service Specialist, Provider Relations and Contracts

2 months ago

Bloomington, United States HealthPartners Full time

HealthPartners is hiring a Provider Relations and Contracting Specialist. This position is the key resource to assigned primary care groups, specialty care groups, hospitals and/or other medical providers (“providers”) participating with the organization’s health plan networks. To maximize the efficiencies and quality of our provider relationships, this position will act as a facilitator to resolve provider inquiries and will assist provider staff in understanding and implementing new and existing HPI products, policies, procedures and systems. This position plays a key role in contract support through fee schedule and contract implementation.

ACCOUNTABILITIES :

Provide excellent customer service to assigned providers by:

Researching and addressing questions related to provider payment, network participation, plan products and programs, and administrative policies and procedures

Serving as liaison between HPI and assigned providers to resolve member concerns in a timely manner

Guiding new provider groups through the onboarding processes necessary to join the HPI network

This includes preparing and coordinating legal contract documents in accordance with the Minnesota Department of Health, government programs, accreditation, and other regulatory agency requirements

This may include supporting the coordination and implementation of new strategic provider partnerships for designated HPI products with use of a work plan and teamwork with other key HPI departments.

Providing pro-active and on-going communication and education to designated provider staff regarding HPI products, policies, procedures, and systems.

This is done through regularly scheduled meetings, ad hoc meetings, phone calls, or special presentations arranged and/or led by HealthPartners staff

Provider staff is defined as business office personnel, receptionists, training staff, referral management staff, physicians, other medical staff, clinic managers, and administrators.

Research, prepare, and communicate provider demographics, network set-up, and reimbursement rates to other departments to ensure internal operations reflect the most current provider information.

The Service Specialist will communicate this data via current systematic processes or electronic forms to the Claims department and other teams.

Participate in contract negotiation meetings, identifying administrative requirements necessary for successful implementation of legal contracts.

Collaborate and problem-solve with internal HPI departments to improve administrative efficiencies that will allow the providers to successfully deliver care to HPI members, to improve contracting opportunities for cost savings and/or to improve administrative interfaces.

Other departments include Claims, Member Services, Provider Data Support, Electronic Commerce, Medical Policy, Utilization Management, Contracted Care Finance, Government Programs, Clinical Pharmacy Services, Other Contracting Departments, and Sales and Marketing.

Complete special projects that are identified through provider relationships, HPI Directors, Contract Managers, or Contract Consultants.

Example projects include:

Devising administrative policies and online tools for provider use

Updating provider resource materials, including new product information documents

Coordinating the implementation of electronic connectivity programs

Creating new provider reports

Streamlining internal processes that involve several internal departments

Developing and implementing audit procedures to determine that contracts have been implemented correctly on the HealthPartners claims processing system

REQUIRED QUALIFICATIONS :

Bachelor’s degree.

Three to five years of managed care experience in a member service, medical management, provider relations, or claims position.

Strong verbal and written communication skills.

Excellent problem identification

and

problem-solving skills.

History of establishing diplomatic working relationships with providers and co-workers.

Intermediate level PC skills.

Strong organizational skills and ability to work independently.

Current, valid, unrestricted Driver’s License (in the state of residence) free of major traffic violations or a pattern of repeated violations for the last 3 years and daily access to a reliable, insured vehicle.

PREFERRED QUALIFICATIONS :

Four years of provider relations experience in a managed care setting (HMO, PPO).

Provider perspective as evidenced by two years experience in a healthcare setting.

DECISION MAKING :

Resolve provider inquiries to the provider’s satisfaction and/or understanding.

Predict and identify problem areas for providers as they implement new HPI processes. Work with providers and internal HPI departments to coordinate operations of the new process.

Identify appropriate resources for setting new systems in place for providers.

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