Provider Relations Specialist

LOCALS ONLY - ONSITE MON - THURS, REMOTE ON FRIDAYS Duration- 1 year DT required The hours are 8 hours daily Monday-Friday, we are a bit flexible with our scheduling, but the earlies would be 7:30am – 4pm and the latest would be 9:30am – 6pm. The Payor Relations Coordinator II (PRC-II), as part of the Payor Relations team, is primarily tasked with the completion of administrative tasks, in support of LMS’ payor-related goals and initiatives. The PRC-II is knowledgeable in multiple administrative areas of payor relations and is highly-skilled in payor-related communications. This position interacts directly with payors and contributes considerably to LMS’ payor relationships and revenue capture. II. PRIMARY DUTIES AND RESPONSIBILITIES 1. Receives and punctually completes work directly from, and through channels established by, the PRM, which may include; a. generation and renewal of credentials; b. maintenance and verification of company participation and demographics with standardized forms of outreach to payors; c. standardized forms of outreach to payors; d. completion and submission of network application forms, contracts, and associated documents; e. review of network participation and limited participation contracts for relevant terms; f. projection and analysis of financial data from new and existing contracts; g. provisional evaluation and comparison of payor contracts and performance; h. completion of contract processing and review documents; i. dissemination of contract and payor policy information to internal stakeholders; j. coordination with and support of payor relations stakeholders; k. routine communications with payors, including resolution of noncritical issues; l. maintenance of payor relations files, folders, databases, and resources; m. completion of various kinds of payor-related reporting; n. monitoring payor relations communications, and disseminating and escalating these as needed; o. supplemental requests related to the above. 2. Maintains a detailed, accurate, proofed or provable, time-based record of work completed and work in progress, and reports this information on an established 3. Supports Payor Relations Manager and Company leadership in other capacities as needed. 4. Performs other duties and tasks as assigned. III. REPORTING RELATIONSHIP RESPONSIBILITIES _X_ No supervisory responsibilities Provides work direction only Provides work direction plus has responsibility for hiring, promotions, transfers, performance management, discipline, and discharge. IV. MINIMUM REQUIREMENTS OR QUALIFICATIONS (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) 1. Education/Experience: High School Diploma or general education degree (GED); two years of relevant experience in insurance verification, medical billing, paralegal, project management, and/or contract administration. 2. Skills: a. Language: Ability to read, analyze, and interpret medical supply publications, technical procedures, and/or training tools. Ability to write internal and external business correspondence. Ability to effectively communicate and present information and respond to questions from management, team members, and/or customers. b. Math: Ability to calculate figures and amounts such as interest, commissions, proportions, and percentages. Ability to apply intermediate math skills. c. Reasoning: Ability to solve practical problems. Ability to manage and address multiple, complex and interdependent variables. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Advanced analytical reasoning to include ability to forecast probabilities within workflow processes and reason against outside factors. d. Computer: Expertise in common Microsoft Office Applications. Ability to learn new applications and increase competency within applications as needed. e. Telecommunications: Ability to utilize or knowledge of call center telecommunications software. f. Licensure or Certifications required: No certifications required V. WORK REQUIREMENTS Ability to work evening shifts, weekends, and overtime as needed. VI. PHYSICAL DEMANDS (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) While performing the duties of this job, the employee is frequently required to walk, sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand. The employee must occasionally lift and/or move up to 10 lbs. VII. WORK ENVIRONMENT (The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) While performing the duties of this position, the employee performs tasks in a temperature- controlled office environment under normal office conditions. The noise level in the work environment is usually moderate. The work environment involves minimal exposure to hazards or physical risks, which require following basic safety #J-18808-Ljbffr