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Provider Relations Specialist

2 months ago

Buffalo, United States Elderwood Full time

Overview:

Elderwood Independent Practice Association (IPA) is seeking an Provider Relations Specialist to join our incredible growing team of professionals.

Why should you join Elderwood IPA?

  • Monday-Friday Schedule w/ no weekends or overnights
  • Hybrid working options
  • Medical, Dental & Vision upon 1st of month following 60 days of hire
  • Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year
  • 401(k) retirement plan with vested employer match up to 4%
  • Substantial Referral program
Responsibilities:
  • Develops a network and conducts recruitment of new providers.
  • Develops and maintains positive relationships with Elderwood Health Plan providers.
  • Serves as a contact for providers and acts as a liaison between the providers and the company.
  • Verifies and reviews provider applications and provider agreements for completion.
  • Follows-up with providers and/or appropriate office staff regarding missing or expired information
    in the credentialing application.
  • Maintains compliance by gathering credentials for contracted providers - obtains valid licenses,
    insurance documents, accreditations, and/or DEA certificates.
  • Performs primary provider source verifications of license, malpractice history, and sanction activity
    through various web-based agencies and sources.
  • Maintains provider credentialing files.
  • Initiates contract negotiations and maintains current contracts and fee schedules.
  • Maintains the PNDS files and prepares for quarterly network submission to the New York State
    Department of Health (NYSDOH); resolves any PNDS errors.
  • Communicates with the NYSDOH regarding provider network data submission.
    Maintains and updates provider directories as needed.
  • Maintain and updates provider manual as needed.
  • Maintains provider information in the database; enters new information or change(s) to existing
    information.
  • Distributes contracts, updates/letters, and any other needed documentation to providers.
  • Performs provider orientations and ongoing provider education, including writing and updating
    orientation materials.
  • Educates providers regarding policies and procedures related to referrals and claims submission.
    Investigates, resolves and communicates provider claim issues.
  • Receives and effectively responds to external provider related issues.
    Accepts and processes incoming Provider Relations department calls.
  • Provides support to Director of Business Development; assists with marketing initiatives as needed.
    Maintains current MLTCP product knowledge.
  • Prioritizes and organizes work to meet deadlines.
  • Travels as needed to providers offices.
  • Provides training for other department specialists and/or coordinators as directed.
  • Assists with future plan projects as directed.
  • Utilizes electronic timekeeping system as directed.
  • Arrives to work on time, regularly, and works as scheduled.
  • Recognizes and follows the dress code of the facility including wearing name tag at all times.
  • Follows policy and procedure regarding all electronic devices, computers, tablets, etc.
    Supports and abides by Elderwood IPAs Mission, Vision, and Values.
  • Abides by Elderwood IPAs businesses code of conduct, compliance and HIPAA policies.
  • Performs other duties as assigned by supervisor, management staff or Administrator.
Qualifications:
  • Minimum of Associate degree; Bachelor preferred
  • Minimum of three (3) years of experience in a managed caresetting, medical office or facility setting with demonstration of medical administration duties
  • Must be in good standing with the Medicare and Medicaidprograms
  • Knowledge of contracts and revision process
  • Knowledge of member service operations
  • Current, valid driver license
    Demonstrated computer skills including Microsoft Office, e-mail systems, electronic medical records, and web-based programs
    Prior medical insurance experience, training and claims processing preferred
  • This position requires regular interaction with residents, coworkers, visitors, and/or supervisors. In order to ensure a safe work environment for residents, coworkers, visitors, and/or supervisors of the Company, and to permit unfettered communication between the employee and those residents, coworkers, visitors, and supervisors, this position requires that the employee be able to read, write, speak, and understand the English language at an intermediate or more advanced level.


EOE Statement:
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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