Provider Relations Specialist

2 days ago


Atlanta, Georgia, United States Kids Health First Full time
Job Summary

We are seeking a highly skilled and detail-oriented Provider Relations Representative to join our team at Kids Health First. This role is crucial in fostering strong relationships with our member practices and ensuring seamless communication and support.

Key Responsibilities
  • Act as the primary point of contact for member practices, addressing their needs and concerns.
  • Assist with the onboarding process for new practices, ensuring a smooth transition into the network.
  • Maintain and nurture relationships with commercial payors and managed care organizations.
  • Resolve escalated claim issues and inquiries, manage data, address service issues, and monitor practice compliance.
  • Collaborate with network staff to identify practice concerns, track issues, and communicate resolutions effectively.
  • Monitor and ensure compliance with network quality standards and educational requirements.
  • Analyze quality metrics to identify providers needing training and documentation/coding resources.
  • Work with other departments to improve HEDIS quality metrics and help practices develop comprehensive, provider-specific plans to enhance their quality performance.
Requirements
  • An Associate degree and a minimum one (1) up to five (5) years managed care experience, including billing/claims, quality, or the equivalent combination of education and experience is necessary.
  • Proficiency in Microsoft Word, Excel, and PowerPoint.
  • Strong interpersonal and listening skills using diplomacy to interact and collaborate with management, external contacts, practices, providers, and all levels of staff.
  • Strong communication and presentation skills to speak effectively before large and small groups of providers in a high-pressure environment and explain complex information clearly and simply.
  • Intermediate conceptual and analytical skills to analyze complex, unstructured problems and propose alternative solutions.
  • Self-motivated to establish priorities, resolve issues, and perform complex functions under limited supervision.
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Detail-oriented with strong organizational skills.
  • Ability to multi-task in a fast-paced environment and exercise independent judgment and follow-through on all tasks.

We offer a dynamic and supportive work environment, opportunities for professional growth and development, and a competitive compensation package.

Apply today to become a part of our team and contribute to the success of Kids Health First



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