Provider Relations Representative Vision Network
3 months ago
SUMMARYThe Provider Relations Representative serves as the primary liaison between Alivi and our network of optometrists and ophthalmologists. 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.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 Optometry and Ophthalmology 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.
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