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Provider Relations Coordinator I
2 months ago
Overview:
The role involves overseeing the administrative and operational functions related to the daily activities of the Physician Hospital Organization (PHO). This includes managing healthcare contracts, fostering provider relationships—both financially and operationally—engaging with payor relations, and contributing to network development among other responsibilities for contracted health plans, working independently and under the guidance of the Executive Director.
The position also entails the ongoing enhancement of centralized facility credentialing within the CHRISTUS Health System Managed Care Department.The responsibilities will encompass provider education, database management, marketing initiatives, and support with provider credentialing and certification as necessary.
Key Responsibilities:
1. Drive network expansion through provider education, service promotion, and office orientations via on-site meetings and diverse communication channels.
2. Facilitate network development through negotiation and processing of contract rates.
3. Act as the primary liaison for providers regarding all network-related inquiries, whether from the provider/physician side or the client company side.
4. Deliver exceptional and prompt customer service with an emphasis on provider retention, ensuring satisfaction among providers, clients, brokers, consultants, and third-party administrators (TPAs).
5. Assist in organizing Board of Director meetings, Credentialing Committee meetings, and other sales meetings as required.
6. Support the credentialing and recredentialing processes.
7. Maintain comprehensive knowledge of PHO contracts and reimbursement methodologies to provide assistance to physicians and healthcare provider office staff.
Maintain awareness of various managed care contracts, including plan types, networks, reimbursement agreements, claims issues, and physician loading procedures.
Communicate updates regarding new contracts and modifications to existing contracts to provider offices.
Ensure that contracted health plans and select payors are informed of any changes in key provider information to maintain accurate records and facilitate claims payment.
Aid in the maintenance of payor network rosters, directors, and matrices to ensure accurate participation records. Request written notifications as needed from health plans or payors.Foster a positive working relationship with PHO physicians and contracted payors to address operational challenges and concerns.
Coordinate and schedule committee and board meetings as needed.
Document committee meetings with detailed minutes and produce final minutes promptly as requested.
Conduct provider education in line with the requirements of each plan, including the development of provider manuals and newsletters, as well as the design, assessment, and delivery of appropriate training.
Organize and facilitate regular meetings of the Office Advisory Committee, which includes key physician office staff, to provide a platform for discussing contracts, claims issues, current news, and updates.
Prepare quarterly accounting invoices, manage daily bank deposits, maintain accurate accounting records, and perform other accounting tasks as necessary.Contribute to the overall administrative functions of the PHO office as required.
Collaborate closely with PHO staff.
Qualifications:
Education/Skills: Bachelor's Degree; proficient computer skills and typing ability.
Strong organizational, interpersonal, and verbal/written communication skills are essential.
Ability to work independently with minimal supervision.
Experience: Two to five years of clerical experience, preferably in a hospital environment or equivalent.
Licenses, Registrations, or Certifications: None required.
Work Type:
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