Associate Provider Relations Representative (44821)

The Associate Provider Relations Representative supports provider outreach and education related to provider compliance with health plan operations and regulatory requirements. Interacts regularly with team members and key internal stakeholders in understanding provider requirements and challenges and develop processes needed to ensure success of department goals. This position builds and maintains positive working relationships with providers, effectively communicating with and educating those providers about the organization, provider responsibilities and resolving provider inquiries.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

• Handle mandatory provider training tracking and outreach processes. Run reports out of Salesforce, review and follow-up as needed.
• Add, update, and maintain provider data in accordance with internal policies and procedures
• Ensure provider email distribution lists are accurate and up to date
• Handle Provider Relations requests from other departments by triaging and/or resolving issues timely
• Ensure Salesforce reporting captures requirements needed for training and other PR interactions
• Perform follow up on any provider non-compliance related to access and availability surveys
• Perform other outreach or tasks as needed to support provider education and compliance
• Assist in finding opportunities for provider training and education
• Work collaboratively interdepartmentally to resolve provider issues to ensure an adequate and satisfied provider network
• Respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
• Assist in finding opportunities to improve the provider experience and participate in implementing provider satisfaction initiatives
• Orient providers on Neighborhood's policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and procedures
• Support Provider Relations team with the development and maintenance of strong professional relationships with providers while functioning as a liaison to the provider community
• Participate in departmental and interdepartmental meetings as appropriate and necessary
• Participate in the development of departmental policies, procedures and processes
• Maintain professional growth and development
• Represent organization at provider related events and other initiatives, as necessary
• Other duties as assigned