Associate Provider Relations Representative

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 proceduresEnsure provider email distribution lists are accurate and up to dateHandle Provider Relations requests from other departments by triaging and/or resolving issues timelyEnsure Salesforce reporting captures requirements needed for training and other PR interactionsPerform follow up on any provider non-compliance related to access and availability surveysPerform other outreach or tasks as needed to support provider education and complianceAssist in finding opportunities for provider training and educationWork collaboratively interdepartmentally to resolve provider issues to ensure an adequate and satisfied provider networkRespond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issuesAssist in finding opportunities to improve the provider experience and participate in implementing provider satisfaction initiativesOrient providers on Neighborhood’s policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and proceduresSupport Provider Relations team with the development and maintenance of strong professional relationships with providers while functioning as a liaison to the provider communityParticipate in departmental and interdepartmental meetings as appropriate and necessaryParticipate in the development of departmental policies, procedures and processesMaintain professional growth and developmentRepresent organization at provider related events and other initiatives, as necessaryOther duties as assignedQualifications Required:Bachelor’s degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experienceExperience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)Ability to interact well with individuals on all levels, and maintain a professional image and attitudeAbility to manage data and processes in multiple platformsAbility to work cross-organizationally to achieve the goals of the company and departmentAbility to work independentlyDetail oriented, with the ability to organize and ability to handle multiple projects simultaneouslyExcellent Customer Service and communication (written and verbal) presentation and facilitation skillsStrong analytical and problem-solving skillsPossess a general understanding of provider and claim operations as they relate to health plansPreferred:Understanding of provider’s reimbursement methodologies and contract termsExperience with facility or professional provider relationsExperience in SharePointExperience with commercial, Medicaid or Medicare reimbursement mechanismsKnowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. #J-18808-Ljbffr Neighborhood Health Plan of Rhode Island