Provider Network Rep

Health Care Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including:
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. Health Care Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

This person will be a primary contact for providers. They will schedule, organize and facilitate collaborative JOC meetings as needed. They will perform provider orientations for individual providers and large provider groups. They will also provide ongoing education for these providers. They will travel to provider’s offices, so they must have a driver’s license.

Everything in bold was added by the hiring manager.

Position

Purpose:

Perform duties to act as a liaison between providers, the health plan and Corporate. Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.

• Serve as primary contact for providers and act as a liaison between the
  home and community based services providers and the health plan
• Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolute
• Schedule, organize and facilitate collaborative JOC meetings as needed.
• Receive and effectively respond to external provider related issues
• Provide education on health plan’s innovative contracting strategies
• Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation,
  MMP updates and related topics
• Perform provider orientations
  for individuals, large diverse provider groups
  and ongoing provider education for same, including writing and updating orientation materials
  which you will present.
• Ability to travel

Requirements:

• bachelor’s degree or equivalent experience
• 1+ years of provider relations or contracting experience
• familiarity with JOC meetings (Joint operating committee meetings) – ability to schedule and organize (these are meetings between providers and the health plan to educate providers and inform them of changes, etc)
• experience acting as a liaison between health plans and providers (can come from the provider side)

Hours for this Position:

M-F 8-5

Advantages of this Opportunity:

• Fun and positive work environment
• Room for growth
• Medical benefits 1st of the month after hire
• 401k Matching

Interested in being considered?

If you are interested in being considered for the position, please contact Ashley Greene at  ext 169.