Summary: 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 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 resolution
· 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 and related topics
· Perform provider orientations and ongoing provider education, including writing and updating orientation materials
· Managing the inbound provider calls
· Managing provider calls and researching provider issues, to include- claims status, contract status, help with credentialing, provider changes- assigning complex cases to account managers.
· May involve outbound calling related to outreach projects as needed.
· Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare or a related field preferred.
· Claims billing/coding knowledge preferred.
· Knowledge of Excel
· 2-4 years of experience