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Provider Relations Representative (ACO)

Prominence Health Plan Amarillo Full-Time
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Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary:  The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within the provider network, including oversight & managing performance in various incentives based and/or value based programs.  Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with participation in the Accountable Care Organization, Prominence Health Plan and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, delivering standard ACO data reports, offering education, technical assistance and problem solving as necessary. 

Job Requirements

Regulatory Requirements:

  • High School Graduate/Equivalent 
  •  Knowledge of provider reimbursement, Medicare reimbursement, coding and Hedis Measures and care gap reporting preferred.
  • Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff

  • Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)

  • Understanding of health plan departments and functional areas for problem resolution

  • Experience in customer service/relations-like roles

Language Skills:

  • Ability to effectively communicate in English, both verbally and in writing.

Skills:

  • Proficient in Microsoft Office skills (Excel, Word, Access, etc.) 

  • Enjoys working in both individual and team settings

  • Problem solver – enjoys problem solving 

  • Self-starter, resourceful and able to execute projects in a fluid and fast paced environment

  • Good communication and relationship skills

  • Strong analytical skills

  • Attention to detail

  • High level of energy

 

Skills required

Customer Service
Problem Solving
Listening
Resolve Customer Issue
Retention Management
Help Customer
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Job ID: 90492

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