Provider Relations Specialist

2 weeks ago

San Angelo, Texas, United States Texas Department of Aging & Disability Services Full time
Job
Description:

Under the guidance of the Program Supervisor and the overall leadership of the Program Manager, this role involves delivering moderately complex consultative services and technical support to program personnel, community organizations, and Texas Health Steps (THS) Providers.

Acts as a THS Provider Representative and intermediary to furnish technical guidance on THS specifics and requirements.

Key responsibilities include conducting various technical tasks, training sessions, research, planning, and program evaluation related to the Texas Health Steps (THS) initiative.

Engages in collaboration and communication with Managed Care Organizations (MCOs) and Texas Medicaid (TMHP) to assist providers with billing inquiries. Conducts consultative visits to Providers and private entities to address program-related concerns, promote the initiative, and facilitate THS Workshops. Performs thorough reviews of THS literature, statutes, regulations, and/or policies and prepares reports as necessary. May offer guidance to fellow THS Provider Representatives. Works in conjunction with public health personnel during regional or state emergencies. Operates under general supervision with some latitude for initiative and independent judgment. Maintains confidentiality.

Essential Job Functions:

Regular attendance is required in accordance with agency leave policies, and other duties may be assigned.

I. Provider Support (45%):

Provides education and updates to retain both existing and new medical, dental, and case management providers; conducts educational activities for community stakeholders regarding THS and Medicaid Services.

Engages in consultative discussions with providers to address program issues, share updates about programs, conduct training sessions, and assist providers in interpreting program policies and procedures.

Aids providers with issues or enhances the understanding of THS providers regarding program policies, requirements, and procedures. Collaborates and communicates with Managed Care Organizations (MCOs) and Texas Medicaid (TMHP) for providers concerning billing matters. Escalates complex issues to the central office promptly to meet provider needs. May assist medical and dental providers in resolving client-related issues with community resources for referrals.

II. Program Support (25%):

Aids in compiling, analyzing, and reporting THS activities to achieve regional program goals and objectives and reports to the Program Manager.

May assist Providers with consumer complaints and corrective action plans with guidance and interpretation. Ensures that provider information is updated annually in the appropriate database as determined by central office or regional requirements.

III. Trainings & Presentations (15%):

Contacts enrolled medical and dental THS providers at least once a year to provide technical assistance through on-site visits that promote education, outreach, and training.

Identifies training needs of providers and offers suitable training and educational sessions. Maintains Vision & Hearing Trainer Certification and conducts provider training as requested. Knowledge of Vision & Hearing Policies and regulations. Familiarity with Medicaid policies and regulations and their program impact.

IV. Community & Outreach Activities (10%):

Participates in community initiatives to promote and market the THS program.

Contacts potential medical, dental, or CPW providers to explain the THS program and collaborates with public health partners to devise strategies for increasing the number of THS providers and retaining current providers.

Attends and engages in regional and statewide THS meetings for program planning.

V. Adherence to Policy and Other Duties as Assigned (5%):

Actively participates and serves in a supportive capacity to fulfill the agency's obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation.

Maintains an acceptable driving record and a valid class C Texas driver's license. Possesses working knowledge of Human Resources, Information Technology, Administrative Policy, and Program Policy. Completes all Public Health Emergency Response, COOP, and other state-mandated training. Reports time, labor, and travel information promptly. Other duties may be assigned by the program manager, including special assignments.

Knowledge Skills Abilities:
Knowledge of Health & Human Service Medicaid programs, Medicaid Managed Care, and Medicaid Managed Care Organizations.
Knowledge of public health and public health practices.
Knowledge of recommended medical developmental screenings for children from birth to 20 years.
Knowledge of recommended dental screenings for children from birth to 20 years.

Skill in public speaking.
Skill in oral and written communication.
Skill in adult training methods.
Skill in analyzing and devising solutions for identified problems.
Skill in interpreting and researching policies, procedures, and regulations.
Skill in collaborating with community agencies, groups, or coalitions.
Skill in working independently, organizing workload, establishing priorities, and completing assigned tasks.
Skill in Microsoft Office Products.

Ability to interpret and apply program policy.
Ability to work in teams and take direction from supervisors.
Ability to establish and maintain effective working relationships with internal and external clients and colleagues.
Ability to develop training materials.
Ability to work independently with minimal supervision.

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