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Provider Relations Representative
1 month ago
Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 3,500 providers including Primary Care, Specialty, Hospital System and ancillary provider partnerships. We have operated in the Arizona market for more than 11 years, and are based in Chandler, Arizona. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost. The Provider Relations Representative is critical to the overall success of the Company. New and established participating providers value great service and maintenance throughout the term of the agreement. Service includes consistent telephonic, face-to-face and written communication and interaction in order to establish and retain positive and successful relationships with the participating provider network. The Provider Relations Representative shall be relationship oriented, requiring someone with an outgoing personality, attention to detail, and firm understanding of the health care delivery system. Maintains a collaborative, advising and attentive attitude at all times as well as represents AZPC with a professional, well-dressed appearance. This individual will be responsible for traveling to and surveying our West Valley Providers. POSITION DUTIES & RESPONSIBILITIES · Assists with investigating and resolving administrative issues and concerns between AZPC, provider network and the health plans. · Develops and maintains provider relationships and serves as the primary resource for internal staff and provider network by maintaining regular schedule of physician office visits to ensure open lines of communication between AZPC and the provider network which also includes ensuring all providers receive timely and accurate information regarding organization initiatives, services, programs, policies and procedures and quality measurements. · Ensures that AZPC Administration are informed of any provider or health plan issues/concerns and supports AZPC Administration by ensuring timely communication and resolution and also coordinates in-office support including, but not limited to: written and oral communication with providers, monthly preparation and distribution of packets, as applicable; Receive and respond to incoming phone calls and emails; and assists with verification of provider effective dates, termination dates, open/closed panel status, demographic information and health plan identification numbers. · Communicate and interact effectively with PCPs, Specialists and other contracted vendors/services through coordination, attendance at regular Office Manager meetings. · Ensures Provider Relations department goals are achieved as assigned, improve quality and business processes for assigned territory of responsibility. · Manages qHMO, AZ Connect, EzNet and other AZPC systems user accessibility for the provider network. · Assists with marketing AZPC by attending and participating in employer group events. · Coordinate the HCC program within the participating provider network by assisting with ICD and CPT coding for coding/billing as assigned. · Review and report statistical data for potential chart review/audit of participating provider network. · Maintain a structured process for quality of audits, tracking and trending including tracking provider network progress on HCC Concurrent program, and coordinate with HCC Department on further trainings. · Maintains detailed and accurate provider contact notes. · Significant travel in your personal vehicle to local provider offices and events. · Special projects and other duties as assigned by management. EDUCATION, TRAINING AND EXPERIENCE · Associates Degree or related equivalent experience – Required. · Prior experience with Network Contracting with physicians. · Proficient in office equipment (computers, printers, etc.) and Microsoft Office programs (Word, Excel, Power Point, Access and Outlook). · EzCap experience a plus. · Excellent written and verbal communication skills. · Ability to maintain confidentiality. · Ability to multi-task and prioritize in a high stress environment. · Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions. · Ability to find, gather and collect information or data. · Preferred knowledge of CPT, ICD, HCPCS, HCC coding; training available for the right candidate. · Knowledge of qHMO & EzCap – Preferred. · Must be able to interact with providers in a professional manner with a strong commitment to positively representing the company. · Current unrestricted Arizona Driver’s license, reliable transportation and proof of insurance required. *This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.* #J-18808-Ljbffr
